Nursing home residents in emergency departments: a Foucauldian analysis
Bibliographic record
Abstract
AIM: This paper is a critical review of current knowledge about use of emergency departments by nursing home residents. BACKGROUND: A great deal of literature focuses on the challenges presented by older adults in acute care environments. Nursing home residents who transfer to emergency departments have been identified as being particularly problematic because they use considerable resources and their needs are not always amenable to acute interventions. METHOD: A literature search was conducted in May 2006 using the CINAHL, Medline and Cochrane databases and Google Scholar with the keywords 'nursing home resident', 'long-term care resident', 'hospital transfer', and 'acute illness and emergency room'. No date restrictions were imposed. Foucault's concept of subjectivity was used to demonstrate how power derived from medical knowledge is used by emergency department personnel to construct nursing home residents as problematic. FINDINGS: Knowledge about the use of emergency departments by nursing home residents has been derived mainly from retrospective record reviews, while the events in nursing homes that lead to transfers have been virtually ignored. Moreover, the primary focus of these investigations has been the effect of residents on emergency departments, rather than how residents themselves were affected. CONCLUSION: Current understanding of the care of nursing home residents in emergency departments is embedded in a complex web of social, historical and political factors. Research is needed that considers multiple perspectives, including those of both emergency department and nursing home staff, residents and ambulance personnel who act as mediators between the two settings.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.029 | 0.083 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.003 |
| Bibliometrics | 0.030 | 0.022 |
| Science and technology studies | 0.003 | 0.004 |
| Scholarly communication | 0.004 | 0.005 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".