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Aims and objectives To understand the experiences and concerns of patients in the emergency department during inpatient boarding. Background Boarding in the emergency department is an increasingly common phenomenon worldwide. Emergency department staff, patients and their families become more stressed as the duration of boarding in the emergency department increases. Yet, there is limited knowledge of the experiences and concerns of boarded patients. Design The qualitative approach of phenomenography was used in the study. Methods The phenomenographic study was conducted in one emergency department that treats approximately 15,000 patients each month. Twenty emergency department boarding patients were recruited between July–September 2014. Semi-structured interviews were used for data collection. The seven steps of qualitative data analysis for a phenomenographic study – familiarisation, articulation, condensation, grouping, comparison, labelling and contrasting – were employed to develop an understanding of participants’ experiences and concerns during their inpatient boarding in the emergency department. Results The perceptions that emerged from the data were collected into four categories of description of the phenomenon of emergency department boarding patients: a helpless choice; loyalty to specific hospitals and doctors; an inevitable challenge of life; and distrust of the healthcare system. The outcome space for the emergency department boarding patients was waiting and hoping for a cure. Conclusion The experiences and concerns of emergency department boarding patients include physical, psychological, spiritual and health system dimensions. It is necessary to develop an integrated model of care for these patients. Relevance to clinical practice Understanding the experiences and concerns of patients who are placed on boarding status in the ED will help emergency healthcare professionals to improve the quality of emergency care. There is a need to develop a car

Background Elders often experience multiple chronic diseases associated with frequent early return visits to emergency departments (EDs). There is limited knowledge of the experiences and concerns of elders during ED return visits. Objectives The purpose of the research was to explore the experiences of elders during ED return visits, with a view toward identifying factors that contribute to return visits. Methods The qualitative approach of phenomenography was used. Data were collected at one ED in a 3,000-bed medical center in Taiwan. Inclusion criteria were aged 65 or above and return visits to the ED within 72 hours of discharge from an index ED visit. The seven steps of qualitative data analysis for a phenomenographic study were employed to develop understanding of participants’ experiences. Results Thirty return-visit elders were interviewed in 2014. Four categories of description were established from the participants’ accounts. These were “being tricked by ED staff,” “doctor shopping,” “a sign of impending death,” and “feeling fatalistic.” The outcome space of elders with early return visits to ED was characterized as “seeking the answer.” Conclusion Index ED visits are linked to return visits for Taiwanese elders through physiological, psychological, and social factors.

Aims and objectives - The purpose of this research was to explore the medical decision-making processes of patients in emergency departments. Background - Studies indicate that patients should be given enough time to acquire relevant information and receive adequate support when they need to make medical decisions. It is difficult to satisfy these requirements in emergency situations. Limited research has addressed the topic of decision-making among emergency patients. Design - This qualitative study used a broadly defined grounded theory approach to explore decision-making in an emergency department in Taiwan. Methods - Thirty emergency patients were recruited between June and December 2011 for semi-structured interviews that were audio-taped and transcribed verbatim. Results - The study identified three stages in medical decision-making by emergency patients: predecision (interpreting the problem); decision (a balancing act) and postdecision (reclaiming the self). Transference was identified as the core category and pattern of behaviour through which patients resolved their main concerns. This transference around decision-making represents a type of bricolage. Conclusions - The findings fill a gap in knowledge about the decision-making process among emergency patients. Relevance to clinical practice - The results inform emergency professionals seeking to support patients faced with complex medical decision-making and suggest an emphasis on informed patient decision-making, advocacy, patient-centred care and in-service education of health staff.

Published research on discharge planning is written from the perspective of hospital wards and community services. Limited research focuses on discharge planning in the emergency department (ED). The objective of this study was to identify ED nurses’ perceptions of factors influencing the implementation of discharge planning. This qualitative study collected data from 25 ED nurses through in-depth interviews and a drawing task in which participants were asked to depict on paper the implementation of discharge planning in their practice. Factors influencing discharge planning were grouped into three categories: discharge planning as a neglected issue in the ED, heavy workload, and the negative attitudes of ED patients and their families. The study highlighted a need for effective discharge planning to be counted as an essential clinical competency for ED nurses and factored into their everyday workload. Nurses perceived that organizational culture, and parents’ and relatives’ attitudes were barriers to implementing discharge teaching in the ED.

During recent reforms to the Taiwanese health care system, discharge planning for hospital patients has become an issue of great concern as a result of shorter hospital stays, increased health care costs and a greater emphasis on community care. There are around five million patients visiting in emergency departments (ED) per year in Taiwan with up to 85% of these, 4,250,000 emergency patients, discharged directly from the emergency department. This significant number of ED visits highlights the need to implement discharge planning in the ED. ED nurses are not only responsible for providing appropriate assessments of a patient's future care needs but also for implementing effective discharge planning as a legal obligation; discharge planning is also a patient's right in Taiwan. For ED nurses to function effectively in the role of discharge planner, it is important that they have a comprehensive understanding of implementing discharge planning. To date, no published research focuses on nurses' experience of implementing discharge planning in the ED in Taiwan. This study is the first step in identifying the experience and understanding of nurses in implementing discharge planning in the ED in Taiwan and may have implications worldwide. The purpose of this study was to identify and describe the experience and understanding of the qualitatively different ways in which ED nurses’ experience of implementing discharge planning for emergency patients in Taiwan. In order to identify and describe the experience of implementing discharge planning, the qualitative approach of a phenomenography was chosen. Thirty-two ED nurses in Taiwan who matched the participant selection criteria were asked to describe their experience and understanding of the implementation of discharge planning in the ED. Semi-structured interviews were audio-taped and later transcribed verbatim. The data analysis process focused on identifying and describing ways ED nurses’ experience and understanding of

AIMS AND OBJECTIVES: To examine underlying factor structure of the Critical Care Family Needs Inventory-Emergency Department across three countries to identify similarities and differences. BACKGROUND: Understanding family needs assists nurses to provide family-centred care to deliver optimal outcomes for critically ill patients and their families in Emergency Departments. DESIGN: Retrospective secondary analyses of data collected in three cross-sectional surveys. METHOD(S): Convenience samples involved recruitment of family members accompanying a critically ill relative into four Emergency Departments in Australia (2), South Africa (1) and Taiwan (1). Item-matched raw data from 374 responses to 40 items from the surveys were collated and analysed using confirmatory factor analysis methods. Reporting adhered to an adapted STROBE checklist. RESULT(S): The factor structure of the 40-item Critical Care Family Needs Inventory-Emergency Department differed between countries. Analyses of the Australian data revealed a four-factor solution comprised of 18 items across four categories of family need (support, communication, participation and comfort); the Taiwanese data also demonstrated a four-factor solution comprised of 13 items (support, communication, participation and comfort); alternatively, the South African data revealed a two-factor solution comprised of nine items (communication and participation). Fifteen items did not match across the countries. However, loading for four items common across all three countries was related to family participation (3) and communication (1). CONCLUSION(S): The findings suggest family members from different countries responded to Critical Care Family Needs Inventory-Emergency Department items in different ways. Consistent with concepts of family-centred care, the study identified participation and communication needs that were common across the countries. The outcomes illustrate the challenge of providing appropriate care for famil