Hunter et al, 2017 CanadaBalancing safety andharm for older adults withdementia in ruralemergency departments:health professionals'perspectivesInterpretative,descriptive exploratorydesign: social ecologicalperspectivePurposive/snowballingsamplingTo understand safetyand harm in rural EDtransitional care forcommunity-dwellingolder adults withdementia fromperspectives of HPs.HPs asked to describetheir experiences ofworking with olderpeople with dementiaand their caregivers inED2 small rural EDs (95inpatient beds/76inpatient beds)12 healthprofessionals: nurses,social worker,occupational therapist,physiotherapist,medicsSemi-structuredinterviewsHP perspectives: ED ischallenging for olderpeople with dementia.Chaotic andovercrowded. Thisgroup not a prioritydue to priorities ofemergency care. HPsometimes too busy togive proper care to thisgroup. Competingpressures in triage.HPs experience moraldistress when theycannot provide carethat they should beable to give. Negativeconsequences: no safespace, no quietenvironment. HPssensitive to familymember situation.Need to look at olderpeople with dementiaand family member asa complete package—obligations to bothSmall ED can be ofbenefit: potential toget older person withdementia out of EDfaster due to goodcommunity links.Disadvantages: makingassumptions orbecoming complacentabout patients whoare well known to HPsMaking things better:more resources,valuing contribution offamily members whocould provide care inED. Changing triageapproach to olderpeople with dementia,getting to know theperson beyond thesuperficial, betterdischarge planning

The text you provided is a summary of a study conducted by Hunter et al. in 2017 in Canada. The study aimed to understand the safety and harm in rural emergency department (ED) transitional care for community-dwelling older adults with dementia from the perspectives of health professionals (HPs).

The study used an interpretative, descriptive exploratory design with a social ecological perspective. The researchers used purposive/snowballing sampling to select participants.

The study was conducted in two small rural EDs, one with 95 inpatient beds and the other with 76 inpatient beds. The participants were 12 health professionals, including nurses, a social worker, an occupational therapist, a physiotherapist, and medics.

Data was collected through semi-structured interviews. The health professionals were asked to describe their experiences of working with older people with dementia and their caregivers in the ED.

The findings of the study revealed that the ED is challenging for older people with dementia. It is often chaotic and overcrowded, and this group is not a priority due to the priorities of emergency care. The health professionals reported that they are sometimes too busy to give proper care to this group due to competing pressures in triage.

The health professionals also reported experiencing moral distress when they cannot provide the care that they should be able to give. The negative consequences include no safe space and no quiet environment for the patients.

The health professionals suggested that it is necessary to look at older people with dementia and their family members as a complete package, with obligations to both.

The study also found that a small ED can be beneficial as it has the potential to get the older person with dementia out of the ED faster due to good community links. However, there are also disadvantages, such as making assumptions or becoming complacent about patients who are well known to the health professionals.

To improve the situation, the health professionals suggested more resources, valuing the contribution of family members who could provide care in the ED, changing the triage approach to older people with dementia, getting to know the person beyond the superficial, and better discharge planning.