Nurses' perspectives of the impact of the older person on nursing resources in the emergency department and their profile: A mixed methods study.
BACKGROUND
Nurses provide the majority of care in the ED, so increases in the number of older people (≥60 years) may impact nursing workload and provision of care.


OBJECTIVE
To determine whom, of older people, emergency nurses perceive as using the most nursing resources and to profile this subgroup from the ED dataset, including illustrative cases.


METHODS
A mixed-methods design study in a metropolitan hospital. Data were collected from focus group interviews with emergency nursing staff (n = 27), from the patient dataset for the corresponding year, and an audit of 13 patients' medical records.


RESULTS
Emergency nurses perceived that the highest demand for their resources came from the older persons representing multiple times in short timeframes (cluster presenter). Cluster presenters had a longer length of stay and required intensive nursing time and vigilance because they had one or more chronic illnesses and comorbid conditions such as limited mobility and dementia. Cluster presenters had to have a full assessment each presentation, were usually admitted to the hospital and admitting specialists were reluctant to assume care.


CONCLUSIONS
Emergency nurses associate a high workload with cluster presenters for reasons including ED processes and availability of expertise. Further research should examine more objectively and precisely nursing workload in this area.
Charles Perkins Centre and Sydney Nursing School, University of Sydney, Camperdown, NSW 2006, Australia. Electronic address: robyn.gallagher@sydney.edu.au.
Robyn
R
Gallagher
Faculty of Health, University of Technology, Sydney, Broadway, NSW 2006, Australia.
Patrick
P
Gallagher
Faculty of Health, University of Technology, Sydney, Broadway, NSW 2006, Australia.
Michael
M
Roche
Nursing and Midwifery Directorate, Northern Sydney Local Health District, Kolling building, Royal North Shore Hospital, St. Leonards, NSW 2065, Australia.
Margaret
M
Fry
Faculty of Health, University of Technology, Sydney, Broadway, NSW 2006, Australia.
Lynn
L
Chenoweth
Faculty of Health, University of Technology, Sydney, Broadway, NSW 2006, Australia.
Jane
J
Stein-Parbury
D000368:Aged; D016529:Emergency Nursing / Q000706:statistics & numerical data*; D006801:Humans; D009726:Nurses / Q000523:psychology*; D010343:Patient Admission; D040841:Resource Allocation / Q000706:statistics & numerical data*; D016526:Workload / Q000706:statistics & numerical data*
Chronic illness; Emergency department; Nurses; Older person; Representation; Workload