Suzanne Goopy

The emergency patient's participation in medical decision‐making

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.

Using the Five-Level Taiwan Triage and Acuity Scale Computerized System: Factors in Decision Making by Emergency Department Triage Nurses

Triage classifies and prioritizes patients’ care based on the acuity of the illness in emergency departments (EDs). In Taiwan, the five-level Taiwan Triage and Acuity Scale (TTAS) computerized system was implemented nationally in 2010. The purpose of this study was to understand which factors affect decision-making practices of triage nurses in the light of the implementation of the new TTAS tool and computerized system. The qualitative data were collected by in-depth interviews. Data saturation was reached with 16 participants. Content analysis was used. The results demonstrated that the factors affecting nurses’ decision making in the light of the newly implemented computerized system sit within three main categories: external environmental, patients’ health status, and nurses’ experiences. This study suggests ensuring the patient’s privacy while attending the triage desk, improving the critical thinking of triage nurses, and strengthening the public’s understanding of the ED visits. These will make ED triage more efficient.

Registered Nurses and Discharge Planning in a Taiwanese ED A Neglected Issue

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.

Becoming new together: making meaning with newcomers through an arts-based ethnographic research design

ABSTRACT This article proposes an arts-based ethnographic research design as a means of engaging in ethical, meaningful, and culturally sensitive research with newcomer communities. Moving away from the manner in which culture has traditionally been defined and studied in psychology, this research design uses cultural probes and subsequent qualitative interviews to collect data about newcomers’ everyday experiences in Canada. Cultural probes are sets of creative items (e.g., cameras, diaries, maps, paint supplies, postcards) that are given to participants to prompt them to document their lives in their new environment. These cultural probes are later unpacked and discussed in individual qualitative interviews. Results are disseminated and archived in ways that are meant to engage and empower communities. Specifically, the process of creating a cultural exhibit collaboratively with participants is discussed.

Exploring newcomer women’s embodied selves: culturally responsible qualitative research

ABSTRACT In recent years, several scholars have called for the construct of embodiment as a meaningful way to explore the ways in which women experience their bodies. However, limited research has explored embodiment specifically amongst newcomer women who are part of visible minority groups in Canada. Although embodiment theories acknowledge the central role of culture in shaping the ways individuals experience their bodies, it remains unclear if and how research can tap into newcomer women’s embodiment in a way that is culturally responsible. Thus, this article will explore how the construct of embodiment offers a meaningful vantage point from which to conduct qualitative research with newcomer women, offering suggestions for working through some of the ethical, methodological, and cultural considerations that may arise in doing so. More specifically, strategies and considerations will be discussed for developing meaningful research questions, engaging in responsible recruitment, building research relationships, attending to culturally responsible data collection, and partaking in embodied reflexivity. Implications for counselling practice and social justice will also be provided.

Elders’ Experiences During Return Visits to the Emergency Department: A Phenomenographic Study in Taiwan

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.