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Patient experience in the emergency department: inconsistencies in the ethic and duty of care

Authors

  • Cheryle Moss PhD, RN,

    Associate Professor, Corresponding author
    1. Faculty of Medicine, Nursing & Health Sciences, School of Nursing and Midwifery, Monash University, Clayton, Vic., Australia
    • Correspondence: Cheryle Moss, Associate Professor, Faculty of Medicine, Nursing and Health Sciences, School of Nursing and Midwifery, Monash University, Clayton Campus, Building 13C, Room C1.80, Clayton, Vic. 3800, Australia. Telephone: +61 3 99053469.

      E-mail: cheryle.moss@monash.edu

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  • Katherine Nelson PhD, RN,

    Senior Lecturer
    1. Graduate School of Nursing, Midwifery & Health, Victoria University of Wellington, Wellington, New Zealand
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  • Margaret Connor PhD, RN,

    Research Fellow
    1. Graduate School of Nursing, Midwifery & Health, Victoria University of Wellington, Wellington, New Zealand
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  • Cynthia Wensley MHSc, RN,

    Research Assistant
    1. Graduate School of Nursing, Midwifery & Health, Victoria University of Wellington, Wellington, New Zealand
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  • Eileen McKinlay MA, RN,

    Senior Lecturer
    1. Primary Health Care & General Practice Department, University of Otago Wellington, Wellington, New Zealand
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  • Amohia Boulton PhD

    Associate Director
    1. Whakauae Research Services, Whanganui, New Zealand
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Abstract

Aims and objectives

To understand how people who present on multiple occasions to the emergency department experience their health professionals' moral comportment (ethic of care and duty of care); and to understand the consequences of this for ‘people who present on multiple occasions’ ongoing choices in care.

Background

People (n = 34) with chronic illness who had multiple presentations were interviewed about the role that emergency departments played within their lives and health–illness journey. Unprompted, all participants shared views about the appropriateness or inappropriateness of the care they received from the health professionals in the emergency departments they had attended. These responses raised the imperative for specific analysis of the data regarding the need for and experience of an ethic of care.

Design

Qualitative description of interview data (stage 3 of a multimethod study).

Methods

The methods included further analysis of existing interviews, exploration of relevant literature, use of Tronto's ethic of care as a theoretical framework for analysis, thematic analysis of people who present on multiple occasions' texts and explication of health professionals' moral positions in relation to present on multiple occasions' experiences.

Results

Four moral comportment positions attributed by the people who present on multiple occasions to the health professionals in emergency department were identified: ‘sustained and enmeshed ethic and duty of care’, ‘consistent duty of care’, ‘interrupted or mixed duty and ethic of care’, and ‘care in breach of both the ethic and duty of care’.

Conclusions

People who present on multiple occasions are an important group of consumers who attend the emergency department. Tronto's phases/moral elements in an ethic of care are useful as a framework for coding qualitative texts. Investigation into the bases, outcomes and contextual circumstances that stimulate the different modes of moral comportment is needed.

Relevance to clinical practice

Findings carry implications for emergency department care of people who present on multiple occasions and for emergency department health professionals to increase awareness of their moral comportment in care.

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