Abstract
Introduction
Prior research suggests that uncertainty related to symptoms is a driver of emergency
department (ED) use, and that patients often leave the ED with uncertainty not being
addressed. Our objective was to engage patients to identify domains that contribute
to feelings of uncertainty and decisions to use the ED.
Methods
We used Group Concept Mapping, a quasi-qualitative/quasi-quantitative method, to elicit
patients’ views on how uncertainty related to experiencing symptoms contributes to
decisions to access the ED. Purposive sampling was used to recruit participants who
either sought treatment at the ED twice within a 30-day period, or visited both the
ED and a primary care provider at least once within the past year.
Results
Thirty-four participants engaged in two rounds of Group Concept Mapping during which
participants participated in structured brainstorming of ideas, followed by ranking
and clustering of ideas into domains. The first round generated 47 idea statements
reflecting uncertainty about consequences, severity, emergency room services, primary
care options, finances, and psychologic concerns. The second round generated 52 idea
statements reflecting uncertainty about self-management, causation, diagnosis and
treatment plan, trust in the provider and institution, accessibility, and alternative
care options.
Discussion
Factors that contribute to uncertainty and decision-making about ED use are both intrinsic
(ie, cause, symptom severity) and extrinsic (ie, finances, accessibility). These domains
can inform approaches to measure the uncertainty that patients experience, and to
design and test interventions for nurses and other providers to help manage patient
uncertainty during acute illness.
Key words
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Biography
Kristin L. Rising is Associate Professor and Director of Acute Care Transitions, Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA.
Biography
Shannon K. Doyle is in the Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA.
Biography
Rhea E. Powell is Assistant Professor, Department of Internal Medicine, Thomas Jefferson University, Philadelphia, PA.
Biography
Amanda M.B. Doty is in the Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA.
Biography
Marianna LaNoue is Research Associate Professor, Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA.
Biography
Angela M. Gerolamo is Associate Professor, College of Nursing, Thomas Jefferson University, Philadelphia, PA.
Article info
Publication history
Published online: June 27, 2018
Footnotes
Earn Up to 7.5 Hours. See page 113.
Identification
Copyright
?©?2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.
