P.T.NGUYEN1, S.Y.LIAW2, A.J.Q.TAN2, S.H.L.GOH3, W.L.CHUA2
Tan Tock Seng Hospital1, National University of Singapore2, Kwong Wai Shiu Hospital3
Nursing home nurses plays a pivotal in recognizing deterioration and initiating the decision-making process on the transfer of residents to emergency departments (ED). However, their transfer decisions have not been adequately explored in the Asian context. This study aimed to explore the experiences and perspectives of NH nurses surrounding the residents’ transfer to EDs during acute deterioration.
A descriptive qualitative study was conducted. Individual semi-structured interviews were held with 14 nurses from the largest single-site nursing home in Singapore.
Five themes emerged: (1) knowing the residents; (2) challenges in honouring residents’ advanced care planning (ACP); (3) family involvement in transfer decisions; (4) nurses as intermediaries between family and physicians; and (5) struggling to shift from curative to palliative thinking.
The development of in-depth knowledge of residents formed the foundation in which nurses’ transfer decisions and referrals to physicians were made without due deliberation. In their decision-making process, nurses negotiated between their own personal value system and the preferences of residents, family members and physicians. However, the priority was given to family’s decisions even in the presence of established ACP. Given the Asian values of collectivism and familism, this study highlights the need for further development of family-centred ACP in Asian long term care facilities. A greater acceptance of death and palliative care among nursing staffs and the general public a may enhance the resident’s end-of-life care.