Lim Siew Hoon1, Sandra Mackey, He Hong-Gu. 1. 1. Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore National University Hospital Centre for Evidence Based Nursing: A collaborating centre of the Joanna Briggs Institute.
Abstract
BACKGROUND: Elderly patients admitted into the emergency department present with high levels of illness acuity and severity, accompanied by multiple and complex medical and psychosocial issues, creating challenges for health care professionals to provide appropriate care. OBJECTIVE: To determine the best available evidence on elderly patients' experiences of care received in the emergency department. INCLUSION CRITERIA: The review considered studies that included male and female patients of all ethnic groups who were 65 years old and above, and admitted to the emergency department with urgent and non-urgent health-related issues. Both quantitative and qualitative studies were included. The phenomena of interest were the experiences of elderly patients in the emergency department. SEARCH STRATEGY: A three-step search strategy was utilised in this review. The following databases were searched for articles published in English before year 2010: CINAHL, Medline, Scopus, PsycINFO, Mednar and Cochrane library. METHODOLOGICAL QUALITY: Each paper was assessed independently by two reviewers for methodological quality prior to inclusion in the review using standardised critical appraisal checklists from the Joanna Briggs Institute. DATA COLLECTION: Data were extracted using standardised data extraction tools from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (MAStARI) for descriptive/case series, and Qualitative Assessment and Review Instrument (QARI) for interpretive and critical research. DATA SYNTHESIS: The findings from the quantitative study were presented in a narrative summary. The findings from the qualitative papers were pooled using JBI-QARI, involving the aggregation of findings to generate a set of statements that represent that aggregation. RESULTS: A total of five papers were included in this review. The quantitative evidence demonstrated elderly patients' satisfaction level with care received in the emergency department was related to the length of waiting time and the information and pain management received. Two syntheses were generated from 12 unequivocal or credible findings from the qualitative evidence: 1) Health care professionals should be aware of the intolerable factors of the waiting experiences and appreciate the positive attitudes of elderly patients at the emergency department in order to improve the care provided; 2) There is a need for improvement for nursing staff to deliver the appropriate attention needed by elderly patients and meet their expectations to deliver professional and competent nursing care. CONCLUSIONS: This review found that elderly patients had negative experiences, which mainly occurred during the waiting period and were related to long waiting time and physical environment. They were generally satisfied with the care they received from nurses. However, they expressed the need for more physiological, psychological and information support IMPLICATIONS FOR PRACTICE: Waiting time should be shortened for elderly patients. Patients' physiological and psychological needs should be paid more attention. The physical environment and facility design of the emergency department should be made more patient friendly. Complete information and clear answers to questions should be provided. IMPLICATIONS FOR RESEARCH: Future studies are needed to better understand elderly patients' needs and their experiences of care at the emergency department; to develop strategies that may improve elderly patients' experiences; to compare the experiences and satisfaction levels of those who have shorter versus longer periods of waiting time; and to explore health care professionals' perception of the care provided to elderly patients in the emergency department.
BACKGROUND: Elderly patients admitted into the emergency department present with high levels of illness acuity and severity, accompanied by multiple and complex medical and psychosocial issues, creating challenges for health care professionals to provide appropriate care. OBJECTIVE: To determine the best available evidence on elderly patients' experiences of care received in the emergency department. INCLUSION CRITERIA: The review considered studies that included male and female patients of all ethnic groups who were 65 years old and above, and admitted to the emergency department with urgent and non-urgent health-related issues. Both quantitative and qualitative studies were included. The phenomena of interest were the experiences of elderly patients in the emergency department. SEARCH STRATEGY: A three-step search strategy was utilised in this review. The following databases were searched for articles published in English before year 2010: CINAHL, Medline, Scopus, PsycINFO, Mednar and Cochrane library. METHODOLOGICAL QUALITY: Each paper was assessed independently by two reviewers for methodological quality prior to inclusion in the review using standardised critical appraisal checklists from the Joanna Briggs Institute. DATA COLLECTION: Data were extracted using standardised data extraction tools from the Joanna Briggs Institute Meta Analysis of Statistics Assessment and Review Instrument (MAStARI) for descriptive/case series, and Qualitative Assessment and Review Instrument (QARI) for interpretive and critical research. DATA SYNTHESIS: The findings from the quantitative study were presented in a narrative summary. The findings from the qualitative papers were pooled using JBI-QARI, involving the aggregation of findings to generate a set of statements that represent that aggregation. RESULTS: A total of five papers were included in this review. The quantitative evidence demonstrated elderly patients' satisfaction level with care received in the emergency department was related to the length of waiting time and the information and pain management received. Two syntheses were generated from 12 unequivocal or credible findings from the qualitative evidence: 1) Health care professionals should be aware of the intolerable factors of the waiting experiences and appreciate the positive attitudes of elderly patients at the emergency department in order to improve the care provided; 2) There is a need for improvement for nursing staff to deliver the appropriate attention needed by elderly patients and meet their expectations to deliver professional and competent nursing care. CONCLUSIONS: This review found that elderly patients had negative experiences, which mainly occurred during the waiting period and were related to long waiting time and physical environment. They were generally satisfied with the care they received from nurses. However, they expressed the need for more physiological, psychological and information support IMPLICATIONS FOR PRACTICE: Waiting time should be shortened for elderly patients. Patients' physiological and psychological needs should be paid more attention. The physical environment and facility design of the emergency department should be made more patient friendly. Complete information and clear answers to questions should be provided. IMPLICATIONS FOR RESEARCH: Future studies are needed to better understand elderly patients' needs and their experiences of care at the emergency department; to develop strategies that may improve elderly patients' experiences; to compare the experiences and satisfaction levels of those who have shorter versus longer periods of waiting time; and to explore health care professionals' perception of the care provided to elderly patients in the emergency department.