Geriatric Palliative Care in Emergency Departments

Table of Contents

Introduction

Drawing attention to widespread situations within emergency care (EC) becomes an important part of addressing previously unperceived but acute healthcare questions. Thus, the article “Emergency department staff priorities for improving palliative care provision for older people: A qualitative study,” published by the peer-reviewed journal Palliative Medicine, draws attention to issues requiring attention within the emergency department (Wright, Lowton, Glenn, Grudzen, Grocott, 2017).

Maintaining a qualitative approach, Wright et al. (2017) have identified “time pressures and limited resources” as factors impeding the adequate provision of emergency geriatric palliative healthcare (p. 12). Therefore, the study helps further possible future understanding regarding the benefit of a choice between increased staff workload and increasing the number of staff within emergency departments (ED), especially considering the aging population phenomenon.

Background of Study

The reasoning behind the article’s creation is backed by a lack of situation-specific ED research within this distinct field of emergency healthcare. The research problem of Wright et al.’s (2017) study is concerned with identifying through specialists’ interviews the clinician-outlined priorities for improving end-of-life geriatric care. Through dialogue with involved healthcare specialists, factors interfering with the process of patient care were identified for amendment, additionally making possible future studies concerning other aspects of emergency care.

Discerning “four key improvement priorities: Communication and Information; Systems and Processes; Understanding of Palliative Care, and Training and Education” permits devising care programs with the appropriate constraints in mind (Wright et al., 2017, p. 2). Therefore, the significance of the study is rooted in its immediate benefit not only for geriatric EC but also for future possible ED-wide research unrestricted to particular sub-departments.

The study was achieved through ED professionals’ collaborative work to identify possible drawbacks to end-of-life care due to an increase in the population’s average age making geriatric patient care an acute issue. The study concerns itself with the opinion of practicing specialists, outlining that a lack of “their insight and involvement leaves quality improvement efforts open to errors and misunderstandings about clinicians capacity, ability and concerns” (Wright et al., 2017, p. 3).

If questions are to be inferred from the paper, they would be concerned primarily with the “what” and “why” of ED issues, as may be inferred from the qualitative approach of the research. Wright et al. (2017) attempt to present their answer on “how” to solve these issues, relying on the results of the conducted interviews, compiling, summarizing, and appraising them. Thus, the purpose of the research may be identified as not furthering simply geriatric EC but as concerned with the professional opinion on how to go about the turning-urgent matter.

Method of Study

Specialist interviews were chosen as an appropriate qualitative method aimed to identify the possible issues within geriatric palliative EC from the healthcare professionals’ point of view. Therefore, the perspective of the study is that of ED specialists, and the papers deal with their immediate experience acquired through involvement in the EC healthcare process (Wright et al., 2017). Identifying healthcare professionals as a study group thus permits appropriately achieving the goal of the article and adequately answering the posed research question.

The source base used by the authors is varied, including both qualitative and quantitative studies related to the chosen topic. However, despite most of them being up to date, the oldest source used is from the 1998s Journal of Advanced Nursing, and many of the others exceed the five years of recommended academic relevance. Despite this, the chosen study’s source base and choice may not invoke particularly strong criticism due to Wright et al.’s (2017) selection including qualitative studies, rather than solely quantitative ones. While a literature review was not carried out in the article explicitly, the chosen literature was handled in the introduction to the research, creating a prerequisite base for the study.

A framework for the study was developed and implemented through coding that assisted the categorization of quotes into appropriate and devised thematic types. In addition to the already mentioned four key improvement priorities within the ED, from an inspection of the conducted interviews, the program identified eight themes that were then compiled into a table (Wright et al., 2017). Through investigating the achieved results, the research was thus brought to a reasonable conclusion regarding the needs of ED specialists when dealing with aged patients.

Results of Study

The eight themes and four improvement priorities that emerged from specialists’ interviews indicated the lack of time, information transmission issues, an absence of an adequately consistent ED system, and a deficiency of palliative care understanding. The research by Wright et al. (2017) found that, when confronted with contradictory situations of palliative and emergency care, healthcare specialists found providing adequate care service a hard to attain endeavor. Therefore, the research-identified improvement priorities present a varied list of issues from different spheres congruent with health care provision.

The implications of these findings and the methods of their achievement on nursing are rooted in interdisciplinary interaction within the ED between EC and palliative care specialists. Addressing questions of administration, management, and even philosophy, the selection of which most specialists tended to avoid, within the ED would permit increasing the quality of care provided to patients, geriatric admittees in particular (Wright et al., 2017). Solving these issues becomes possible through the inclusion of specialists from different fields, each contributing their expertise and knowledge.

Ethical Considerations

As an England-based study, the National Research Ethics Service and a London Research Ethics Committee approved the investigation. The privacy of health care receivers was indirectly protected through specific cases not being mentioned and interviewees taking an overall ED stance (Wright et al., 2017). The agreement of the clinicians participating in the study was received in writing beforehand, with optional parts of the study such as “feedback sessions” receiving full attendance by all actors of the study (Wright et al., 2017, p. 5). However, information about patient and specialist privacy was not explicitly stated over the length of the article and had to be inferred from the listed methods of the research.

Conclusion

Despite some drawbacks in the research’s documentation, the study remains an essential step in advancing palliative EC, especially considering that most of the identified setbacks could be applied ED-wide. Addressing systematic ED issues through an age-specific experience could permit developing not only better healthcare time and quality for patients but also permit instituting better structure and management.

However, while the study attempts to present a solution in an inter-disciplinary collaboration of ED professionals and training, this seems hard to implement due to a lack of human resources. Therefore, through an apperception of knowledge of ED specialists’ opinions on the operability of the system, the study permits identifying possible solutions to the increased time versus increased staff debate.

References

Wright, R. J., Lowton, K., Glenn, R., Grudzen, C. R., & Grocott, P. (2017). Emergency department staff priorities for improving palliative care provision for older people: A qualitative study. Palliative Medicine, 32(2), 1-17. Web.

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