What relatives of older medical patients want us to know - a mixed-methods study

Abstract Background Relatives of acutely hospitalised older medical patients often act as case managers during a hospital trajectory. Therefore, relatives’ experiences of collaboration with staff and their involvement in care and treatment are highly important. However, it is a field facing many challenges. Greater knowledge of the values and areas that are most important to relatives is needed to facilitate the health care staff to better understand and prepare themselves for collaboration with relatives and to guide family care. Methods The aims were to 1) describe the aspects of collaboration with staff during the hospital care trajectory emphasised by relatives of older medical patients 2) compare the characteristics of relatives who wrote free-text notes and those who did not. Relatives of acutely hospitalised older medical patients responded to a structured questionnaire (n = 180), and nearly half wrote free-text comments (n = 79). Free text was analysed with qualitative content analysis. Differences between (+) free text/ (−) free text groups were analysed with χ2 test and Kruskal-Wallis test. Results Analysis disclosed three categories I) The evasive white flock, concerning the experienced evasiveness in staff attitudes and availability, II) The absence of care as perceived by the relatives and III) Invisible & unrecognised describing relatives’ experience of staff’s lack of communication, involvement and interactions with relatives especially regarding discharge. Significant differences were found between relatives who wrote free-text and those who did not regarding satisfaction, trust and having a health care education. Conclusions This study provides knowledge of aspects relatives of older medical patients find particularly problematic and, further, of characteristics of relatives using the free-text field. Overall, these relatives were met with evasiveness from staff, an absence of care and felt invisible and unrecognised in the lacking collaboration with staff. Hence, strategies to ensure quality care and systematic involvement of relatives are needed, and the findings in this study may contribute to, and guide, quality improvement of family centered care in acute hospital wards

An Ethnographic study of unhealthy alcohol use in a Danish Emergency Department

BACKGROUND: Emergency Departments (EDs) are important arenas for the detection of unhealthy substance use. Screening, Brief Intervention, and Referral to Treatment (SBIRT) for unhealthy alcohol use has been used in some ED settings with funding support from external sources. However, widespread sustained implementation is uncommon, and research aimed at understanding culture as a determinant for implementation is lacking. This study aims to explore cultural practices concerning the handling of patients with unhealthy alcohol use admitted to an ED. METHODS: An ethnographic study was conducted in an ED in the Capital Region of Denmark. The data consists of participant observations of Health Care Professionals (HCPs) and semi-structured interviews with nurses. Data was collected from July 2018 to February 2020. A cultural analysis was performed by using Qualitative Content Analysis as an analytic tool. RESULTS: 150 h of observation and 11 interviews were conducted. Three themes emerged from the analysis: (1) Setting the scene describes how subthemes “flow,” “risky environment,” and “physical spaces and artefacts” are a part of the contextual environment of an ED, and their implications for patients with unhealthy alcohol use, such as placement in certain rooms; (2) The encounter presents how patients’ and HCPs’ encounters unfold in everyday practice. Subtheme “Professional differences” showcases how nurses and doctors address patients’ alcohol habits differently, and how they do not necessarily act on the information provided, due to several factors. These factors are shown in remaining sub-themes “gut-feeling vs. clinical parameters,” “ethical reasoning,” and “from compliance to zero-tolerance”; and (3) Collective repertoires shows how language shapes the perception of patients with unhealthy alcohol use, which may cause stigma and stereotyping. Subthemes are “occupiers” and “alcoholic or party animal?”. CONCLUSIONS: Unhealthy alcohol use in the ED is entangled in complex cultural networks. Patients with severe and easily recognizable unhealthy alcohol use—characterized by an alcohol diagnosis in the electronic medical record, intoxication, or unwanted behavior—shape the general approach and attitude to unhealthy alcohol use. Consequently, from a prevention perspective, this means that patients with less apparent unhealthy alcohol use tend to be overlooked or neglected, which calls for a systematic screening approach. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13722-021-00269-z