作為中間人的克服和協調：轉送長照機構住民至急診的護理經驗

Being a Middleman-Overcoming and Coordination: Nursing Experiences of Transferring Long-Term Care Residents to Emergency Departments

陳柏安(Bor-An Chen) ； 鄭綺(Chii Jeng)

《新臺北護理期刊》 21卷2期 (2019/09) Pp. 39-51

https://doi.org/10.6540/NTJN.201909_21(2).0004

摘要

背景：長照機構沒有醫師駐診，護理師是主要健康照護提供者，當發現機構住民異常徵象時，須獨立面對考量急診就醫因素如：住民／家屬自主決定、機構的資源及經營、醫療糾紛和急診醫療等。面對多元的考量，護理師對機構住民急診就醫的決策過程經常備受壓力與挑戰，但過去很少研究深入探討此問題。目的：探討長照機構護理師轉送住民急診就醫之經驗，期能作為制定長照機構住民送醫標準流程之參考。設計：使用紮根理論質性研究法進行研究。方法：訪談20位具一年以上長照機構工作經驗的護理師，以訪談指引、深度訪談和滾雪球取樣法，進行資料收集。結果：「作為中間人的克服和協調」是敘述轉送機構住民急診就醫經驗的核心類屬，在此過程中「異常健康問題」是前驅類屬，護理師在經歷四個連續過程類屬，並在類屬間產生互動關係（a）「急診就醫考量」（b）「給予罹病住民緩和照護」（c）「轉送的關鍵決策」（d）「多元協調」。此外住民急診就醫後是否返回原機構，護理師也會面對許多困擾和矛盾情境。結論與建議：良好的溝通，協調以及獨立判斷急緩和處理的能力是關鍵因素，建立長照機構住民送醫標準流程及運送急診護理之在職教育非常重要。

關鍵字

決策 ； 紮根理論 ； 急診就醫 ； 長期照護 ； 協調 ； 溝通 ； 護理人員

並列摘要

Background: As there is no regulation of resident physicians available in long-term care facilities (LTCFs), nurses serve as a main health provider in LTCFs. When finding the LTCF resident's abnormal signs of health status, nurses must consider independently for decision-making process of transferring emergency departments (EDs) related factors such as residents/family own decision, LTCFs resources and operations, medical dispute, and relevant medical treatments at EDs. LTCF nurses indeed make a hard decision of whether sending the resident to the ED for treatment, which they frequently face the situation about the pressure and challenges. However, little research is delved into this issue in the past. Objective: This study aimed to investigate LTCF nurses' experiences of transferring residents to EDs and the results may serve as a reference for making a standard operation procedure for the LTCF residents transferred EDs in the future. Design: This study adopted a grounded theory qualitative research method. Method: Twenty nurses who had at least one year work experience were recruited. Utilization of interview guide, in-depth interview and snowball sampling was conducted to collect data. Results: ＂Being a Middleman - Overcoming and Coordination＂ was the core category for describing the process of transferring residents to EDs. During this process, ＂abnormal findings＂ was antecedent condition. There were four categories about nurses' experiences within transferring LTCF residents to EDs and marked by action and interactions among (a)＂initiation of transfer consideration＂ (b) ＂providing palliative care for sick residents＂ (c)＂key decisions for transfer＂, and (d)＂multiple coordination＂. Furthermore, residents finished medical treatment at EDs whether deciding or not to return the original LTCF, LTCF nurses would face many troubling issues and paradoxical situations. Conclusion and Implication: Favorable communication, coordination and abilities of judging independently to deal with the residents by urgent/palliative treatment are key elements. For these reasons, they are very important to establish a set of the sending standard processes and a set of emergency nursing care educations for the LTCF nurses.

並列關鍵字

decision-making ； grounded theory ； emergency visit ； long-term care ； coordination ； communication ； nursing staff

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