| Summary: | 碩士 === 臺北醫學大學 === 醫學人文研究所 === 102 === Background :
Emergency department over-crowding already exists in the current situation in most of medical centers. Scholars do quite a lot of studies in emergency resources consumption, but few in-depth qualitative research methods to understand how emergency patients visited emergency department. In this study, looking in depth emergency environment, to understand the use of non-emergency patients to emergency department, and to explore how the emergency first-line clinical staff feel about this phenomenon.
Methods :
In this study, qualitative research methods, using semi-structured one by one in-depth interview way of gathering information. Studied first with maximum variation sampling and then with the purposive sampling method. A densely populated metropolitan teaching hospital emergency department northern region of Taiwan , the emergency physician, nurse and social worker for the respondents to explore experience in direct contact with non-urgent patients, ideas and attitudes. The number of samples in order to achieve data saturation was the end.
Conclusion :
After two stages of 12 interviews (containing a total of 12 respondents, three emergency physicians, seven nurses and two social workers) and three levels of data analysis (written verbatim, clustering, cluster analysis) to obtain five important observations. First, people''s muse: convenient, cheap, patients have no idea about the use of emergency resources processes, trust medical center, trust specialty medicine, and the first choice of patients who homeless or not familiar with public resources. Second, contradiction of emergency physicians: non-urgent patients are required to develop an emergency physician education, it is easy to handle simple disease, and the ecological balance on the business owner and employment. Third, shout of nurses: The first-line of facing impact, lack of manpower, limited emergency resources, there is no way to satisfy the needs of every patient, ignore professional, and facing the external and internal pressures simultaneously. Fourth, the risk of non-urgent patients: hardware and software devices are used by non-urgent patients, and unable to properly assess the patient. Finally, not everyone wants to change: institution and education unable to solve the problem immediately, the only we can do to change the status is try to internal coordination.
Discussion :
This "The medical behavior of non-urgent patients visited emergency department." qualitative research revealed that when we shouting to change unfriendly medical environment, physicians and nurses are on the same side. In fact, patients do not change their behavior because they get cheaper, convenient way for medical treatment. Although clamoring for change, physicians still has positive attitude about the status of the medical environment. The nurses work hardly but could do nothing to change the environment. We also found several interesting questions: "understanding gap", "different feelings of physicians and nurses", "the meaning of emergency department over-crowding" worthy to continue the discussion.
The issue of emergency department over-crowding has existed for long time, the way we can change are: first, a leader understand the loading of emergency department. Second, the emergency department entrance control. Third, keep all the emergency inspections and examinations smoothly. Fourth, the implementation of health education.
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