“Nurses caught in the middle”: A qualitative study of nurses’ perspectives on the decision to transfer deteriorating nursing home residents to emergency departments in Singapore

What is it about?

Background Nursing home nurses are pivotal in recognising resident deterioration and initiating the decision-making process on resident transfer to emergency departments. However, their decisions have not been adequately explored in the Asian context which places a strong emphasis on family connection and has a longstanding history of considering end-of-life discussion as a taboo. Aim To explore the experiences of nursing home nurses surrounding resident transfer to emergency departments during acute deterioration. Methods A descriptive qualitative study was undertaken. Individual semi-structured interviews were held from October to December 2019 with a purposive sample of 14 nurses from one nursing home in Singapore. Thematic analysis was performed on the data. Findings Five themes were identified: (i) knowing the residents; (ii) challenges in honouring residents’ advance care planning; (iii) family involvement in transfer decisions; (iv) nurses as an intermediary between family and physicians; and (v) struggling to shift from curative to palliative thinking. Discussion In-depth knowledge of residents facilitated nurses’ transfer decisions and physician referrals were made without deliberation. In their decision-making process, nurses negotiated between their own personal value system - a preference for life-sustaining therapies - and balancing the interests and preferences of residents, family members, and physicians. Priority was given to families’ decisions even in the presence of established advance care planning. Conclusion This study highlights the need for further development of family-centred advance care planning in Asian long-term residential care. A greater acceptance of palliative care among nursing home staff and the public may improve the end-of-life care quality for residents.

Featured Image

Photo by camilo jimenez on Unsplash

Photo by camilo jimenez on Unsplash