Frailty means falling between the cracks: A qualitative study exploring emergency nurses' understanding of frailty and its use in informing clinical decision-making related to acuity, care, and disposition.

THE PURPOSE: Of this study was to understand emergency nurses' use of frailty to inform care, disposition decision-making, and further assessment. METHODS: A qualitative, descriptive, exploratory approach was used. Field notes from group discussions held during a conference presession on frailty and post-session evaluation data were analyzed. RESULTS: Two common ideas threaded these discussions: frailty as vulnerability to "falling through the cracks" and that of an iceberg. Participants stressed the broad and expansive ramifications of frailty, and lack of structure/process to accurately describe, quantify, and utilize the concept. Participants described issues of physical and emotional/social fragility, including being unable to complete activities of daily living independently; also of concern were the patients' social determinants of health and financial challenges. CONCLUSION: The conceptual understanding of frailty encompassed physical, social, cognitive, and access deficits. Emergency nurses are aware of this concept and would conduct formal frailty screening if provided with training, time, and resources.

Identifying obstetrical emergencies at Kintampo Municipal Hospital: a perspective from pregnant women and nursing midwives.

A hospital based cross-sectional qualitative study was conducted at Kintampo Municipal Hospital in Northern Ghana, to identify obstetric emergencies and barriers to emergency care seeking; examine the perspective of midwives regarding their role in maternity care and management of obstetric emergencies, and explore women's knowledge and response to obstetric emergencies. Study subjects comprised of 2 emergency obstetric cases, 29 antenatal focus group discussants and 5 midwives at the maternity unit. Data was collected from 23rd March to 9th April, 2012 using in-depth interviews, focus group discussions and record reviews. The most common obstetric emergencies were hemorrhage, eclampsia and anemia. Potential obstetric complications were poorly understood by antenatal women and known barriers limited access to emergency obstetric care. Service challenges included insufficient staffing and well as inadequate equipment and physical space in the maternity ward. Local community efforts can address communication and service access gaps. Government intervention is required to address service provision gaps for improved maternity care in Kintampo.