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A multiple case study of patient journeys in Wales from A & E to a hospital ward or to home with the support of the early response service

Manning, Sera Nia ORCID: 2014. A multiple case study of patient journeys in Wales from A & E to a hospital ward or to home with the support of the early response service. Cardiff University.
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OBJECTIVE - This research discovers patients’ experiences of the new and traditional routes of care and reveals the advantages and disadvantages of each within a chosen locality. It informs how a community service is delivering the new health agenda and most importantly how the patients feel and perceive their journeys through community-based care and hospital-based care. Therefore, its findings are crucial as feedback on how successful health plans have been to move more care to the community. It will reveal the Early Response team’s processes to ensure the service is fully utilised in intermediate care and give a better understanding about which patients are suitable for the home service. DESIGN – This qualitative research takes the form of multiple case studies encompassing semi-structured interviews to encourage discussion on the topic of care journeys. Participant information sheets and consent forms were used. The anonymity of the participant was upheld by using a pseudonym to refer to their contribution. All patients gave consent for the staff member who assessed them to be interviewed giving a total of three case study sources of the home patient, the hospital patient and the staff member as the units of measurement. Themes were searched for in the coding process derived from Kolcaba’s (2010) comfort theory and the bio-psycho-social model (Engel, 1977). These were physical, psychological, social and environmental along with two themes derived from the literature review of age discrimination and loneliness. Data generated helped ascertain the success of an alternative type of care service and formulated recommendations for practice. SETTING - The patient interviews took place at the patients’ home so that they had time to experience their care pathway. Staff interviews took place in a quiet room at their place of work. Flexibility was offered regarding location, time of day and if the patients wished relatives to be present. PARTICIPANTS - 10 patients and 10 staff were interviewed totalling 20 participant interviews. The patient group was split into 5 patients who attended A & E and received their subsequent care in hospital and 5 patients who attended A & E and 4 were able to receive their subsequent care at home with the Early Response Service. The patients from each group were matched on the basis of same/similar injury. Each staff member who assessed the patients was matched to their patient, giving a multiple case study of the home and hospital patient and two staff members. The age range of patient participants was 72-89 years old and the staff participants 39-58 years old. There were 8 females and 2 males in the patient group and 9 females and 1 male in the staff group. RESULTS – Data were analysed using the six theme headings and by searching through data for specific reference to answering the research questions. Key words found were burden, coping, independence or dependence, recovery, pain, equipment, finance, frailty and disorientation. Comfort took the form of pain relief, carer assistance and reassurance, not feeling a burden and having needs met in a timely fashion. Discomfort took the form of pain, cold, hunger, loneliness, finances, disorientation and needing more flexibility in carer calls. Tabular analysis revealed all hospital admissions were necessary and the reasons for admission were more serious or required medical/surgical intervention compared to the home care group. Positive home patient comments included being able to have care at home with less disruption to patients’ social networks and positive hospital patient comments included being able to receive maximum assistance over a 24 hour period as they felt they could not have coped at home. Results in relation to ageing theory, age discrimination and loneliness are discussed and interestingly care at home can be interpreted as positive discrimination of the older person by offering an alternative care option. Both hospital and home patients were satisfied with the care they received on the whole. CONCLUSION – The Early Response Service are correctly identifying the most suitable patients to receive care at home. An improvement in staff resources or skills such as intravenous drug administration would widen their referral criteria to be able to offer their service to more patients. There is still work to be done in respect of pulling patients out of hospital who are deemed medically stable, but are waiting for social care packages.

Item Type: Thesis (Other)
Status: Unpublished
Schools: Healthcare Sciences
Subjects: R Medicine > R Medicine (General)
R Medicine > RT Nursing
Funders: Florence Nightingale Foundation sponsor
Date of First Compliant Deposit: 30 March 2016
Last Modified: 25 Oct 2022 09:48

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