| Learning Objective #1: Identify emergency nurses' experiences in working with individuals with mental retardation | |||
| Learning Objective #2: Assess, using conjoint analysis ER nurses' health care decision-making for this vulnerable population |
Methods: Experiences in working with MR patients were assessed through open ended questions of 23 ED nurses which were tape recorded. In addition, health-care decision making was studied using conjoint analysis. Each nurse ranked their likelihood of approving a minor surgical procedure. Each set of rankings was transformed by conjoint analysis into factor utilities, from which was computed the percentage contribution of each factor to the care decision made by each nurse. The qualitative interviews were transcribed verbatim, and content analyzed.
Results: Two nurses found the ranking task too complicated. Mean ‘importance' values for the 21 nurses respondents were: Likely Future Health Status 39%, Family Input 19%, Extra Cost to Agency 12%, Person's Age 13%, Functional Status 10%, and Mental Competence 6%. The percentages listed explain the weight assigned by the nurse for each factor in the decision. Subgroups each with a discrete decision making pattern were identified. Nurse's age, education, and years' experience did not discriminate among evaluative patterns. Nurses perceived care for the MR patient to be “difficult” due to communication barriers and a general lack of experience and knowledge in providing care for this population. A lack of comfort and frustration was also expressed related to provision of care.
Conclusions and Implications: Future health status was ranked more important by nurses in making health care decisions for individuals with MR. An understanding of nurses' perceptions factors into both quality and access to care for this vulnerable population.