作為中間人的克服和協調：轉送長照機構住民至急診的護理經驗

Background: As there is no regulation of resident physicians available in long-term care facilities (LTCFs), nurses serve as a main health provider in LTCFs. When finding the LTCF resident's abnormal signs of health status, nurses must consider independently for decision-making process of transferring emergency departments (EDs) related factors such as residents/family own decision, LTCFs resources and operations, medical dispute, and relevant medical treatments at EDs. LTCF nurses indeed make a hard decision of whether sending the resident to the ED for treatment, which they frequently face the situation about the pressure and challenges. However, little research is delved into this issue in the past. Objective: This study aimed to investigate LTCF nurses' experiences of transferring residents to EDs and the results may serve as a reference for making a standard operation procedure for the LTCF residents transferred EDs in the future. Design: This study adopted a grounded theory qualitative research method. Method: Twenty nurses who had at least one year work experience were recruited. Utilization of interview guide, in-depth interview and snowball sampling was conducted to collect data. Results: ＂Being a Middleman - Overcoming and Coordination＂ was the core category for describing the process of transferring residents to EDs. During this process, ＂abnormal findings＂ was antecedent condition. There were four categories about nurses' experiences within transferring LTCF residents to EDs and marked by action and interactions among (a)＂initiation of transfer consideration＂ (b) ＂providing palliative care for sick residents＂ (c)＂key decisions for transfer＂, and (d)＂multiple coordination＂. Furthermore, residents finished medical treatment at EDs whether deciding or not to return the original LTCF, LTCF nurses would face many troubling issues and paradoxical situations. Conclusion and Implication: Favorable communication, coordination and abilities of judging independently to deal with the residents by urgent/palliative treatment are key elements. For these reasons, they are very important to establish a set of the sending standard processes and a set of emergency nursing care educations for the LTCF nurses.