title: Caring for acutely unwell older residents in residential aged-care facilities: Perspectives of staff and general practitioners.
abstract: OBJECTIVE
  To explore the challenges and facilitators of managing acutely unwell residents in their residential aged-care facilities (RACF) and transferring RACF residents to the emergency department of a tertiary referral hospital in Australia.
  
  
  METHODS
  This exploratory study used a qualitative descriptive approach incorporating structured focus group interviews with nursing staff from RACFs and General Practitioners (GPs) within the local area. Four focus groups were held with staff from RACFs and one with GPs who visited one or more of the facilities during 2010. The interview data were analysed for themes relating to the study aims.
  
  
  RESULTS
  Findings revealed both challenges and facilitators associated with managing acutely unwell older people including, communication, nursing staffing mix and numbers, use of advanced care directives, responsibilities of GPs and awareness of community services.
  
  
  CONCLUSIONS
  From these findings it is possible to make recommendations for alternative ways of practising and/or new models of care.
authors.affiliation: Hunter New England Local Health District, Newcastle, New South Wales, Australia.
authors.forename: Amy
authors.identifier: http://orcid.org/0000-0002-7497-6407
authors.initials: A
authors.lastname: Stokoe
authors.affiliation: Division of Emergency Medicine, John Hunter Hospital Hunter New England Local Health District, Newcastle, New South Wales, Australia.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Hullick
authors.affiliation: School of Nursing and Midwifery, Faculty of Health, The University of Newcastle, Newcastle, New South Wales, Australia.|Centre for Practice Opportunity and Development, Hunter New England Local Health District, Newcastle, New South Wales, Australia.
authors.forename: Isabel
authors.initials: I
authors.lastname: Higgins
authors.affiliation: Emergency Department, John Hunter Hospital, Hunter New England Local Health District, Newcastle, New South Wales, Australia.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Hewitt
authors.affiliation: Older Person Acute Care, Hunter New England Local Health District, Newcastle, New South Wales, Australia.
authors.forename: Deborah
authors.initials: D
authors.lastname: Armitage
authors.affiliation: Older Persons Journey, Community Health Strategy, Hunter New England Local Health District, Newcastle, New South Wales, Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: O'Dea
mesh_terms: D000208:Acute Disease / Q000628:therapy*; D001291:Attitude of Health Personnel; D004636:Emergency Service, Hospital; D058005:General Practitioners / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006707:Homes for the Aged; D006801:Humans; D007407:Interviews as Topic; D009517:New South Wales; D009735:Nursing Homes; D010348:Patient Care Team; D010360:Patient Transfer; D024382:Professional Role; D036301:Qualitative Research; D062606:Tertiary Care Centers
keywords: aged; emergency medicine; health services for the aged; nursing homes; patient transfer