Abstract
Background: Hospital admissions are frequent among nursing home residents. However, hospital admissions within this population are associated with an increased risk of delirium, hospital-acquired infections, functional disability, and mortality. In addition, hospital admissions from nursing homes are often assessed unnecessary, though it is a major focus in healthcare planning. This calls for changes in the way of providing appropriate acute care to this population and new initiatives are being explored. However, little is known about the phenomena acute events in a nursing home setting as well as recognition and management of resident deterioration in nursing homes. This study aims to explore and understand the circumstances of acute events among residents in a nursing home setting.
Approach: A qualitative study with an explorative approach. Field observations and informal interviews will be used as method. The field observations provide first-hand insight into how acute deterioration is recognized and managed in nursing homes, and the importance of the contextual conditions surround-ing these situations. During the observations, it is expected to gain insight into whether practice aligns with the verbal communication. Participants will include nursing home residents, their relatives, staff members, and other healthcare professionals involved in acute events. The study is conducted in four nursing homes within a single municipality in Denmark. To ensure involvement of both participants and the broader community, we have established an advisory group consisting of representatives from the municipality's council for the elderly, and a Steering Committee comprising municipal leaders, depart-ment chiefs and researchers. Both groups will contribute valuable perspectives throughout design and implementation with their input being carefully considered.
Results: Pre-liminary findings indicate four main themes: 1) Staff Perceptions and Competencies are important in Acute Event Recognition, 2) Cross-Sector Organization and Collaboration matter in Acute Event Management, 3) Hospitalization is not the quick solution, and 4) Macro-level Circumstances are significant to the older person. Findings are based on observations and informal interviews on participant characteristics, activities, behavior (verbal and non-verbal), interactions and communication, artefacts and organizational conditions such as culture, resources and procedures.
Implications: This study may be the first field observational study to explore the phenomenon of acute events in a Danish nursing home setting. Understanding acute events as phenomenon and the circumstances surrounding these events are essential for developing quality healthcare for nursing home residents. This study is a part of PhD project also exploring possibilities to ensure residents' personal integrity in management of acute events as well as the decision-making process. All this combined may help identify areas for enhancing specialized and personalized emergency care for nursing home residents, considering both resident autonomy and the available resources in the nursing home.