Managing "socially admitted" patients in hospital: a qualitative study of health care providers' perceptions.

BACKGROUND: Emergency departments are a last resort for some socially vulnerable patients without an acute medical illness (colloquially known as "socially admitted" patients), resulting in their occupation of hospital beds typically designated for patients requiring acute medical care. In this study, we aimed to explore the perceptions of health care providers regarding patients admitted as "social admissions." METHODS: This qualitative study was informed by grounded theory and involved semistructured interviews at a Nova Scotia tertiary care centre. From October 2022 to July 2023, we interviewed eligible participants, including any health care clinician or administrator who worked directly with "socially admitted" patients. Virtual or in-person individual interviews were audio-recorded and transcribed, then independently and iteratively coded. We mapped themes on the 5 domains of the Quintuple Aim conceptual framework. RESULTS: We interviewed 20 nurses, physicians, administrators, and social workers. Most identified as female (n = 11) and White (n = 13), and were in their mid to late career (n = 13). We categorized 9 themes into 5 domains: patient experience (patient description, provision of care); care team well-being (moral distress, hierarchy of care); health equity (stigma and missed opportunities, prejudices); cost of care (wait-lists and scarcity of alternatives); and population health (factors leading to vulnerability, system changes). Participants described experiences caring for "socially admitted" patients, perceptions and assumptions underlying "social" presentations, system barriers to care delivery, and suggestions of potential solutions. INTERPRETATION: Health care providers viewed "socially admitted" patients as needing enhanced care but identified individual, institutional, and system challenges that impeded its realization. Examining perceptions of the people who care for "socially admitted" patients offers insights to guide clinicians and policy-makers in caring for socially vulnerable patients.

Childbirth-related post-traumatic stress disorder in couples: a qualitative study.

OBJECTIVES: Previous research has established that women can develop childbirth-related post-traumatic stress disorder (PTSD), but the effect of this on a couple's relationship has not been examined. This study aimed to look at the experience and impact of childbirth-related PTSD in women and their partners. DESIGN: This was a qualitative interview study of six couples, where at least one partner had clinically significant symptoms of childbirth-related PTSD. METHODS: Semi-structured interviews were conducted separately with each partner and interview transcripts subjected to thematic analysis. RESULTS: Analysis identified four themes with 18 subthemes as follows: (1) birth factors (pain, negative emotions in labour, perceived lack of control, lack of choice or lack of involvement in decision-making, restricted movement or physical restraint, and expectations not being met); (2) quality of care (information provision, staff factors, continuity of care and environment); (3) effects on relationship with partner (impact on physical relationship, communication within the relationship, negative emotions within the relationship, receiving or giving support from partner, coping together as a couple and overall effect on the relationship); and (4) effects on relationship with child (perceptions of the child and parent-baby bond). CONCLUSIONS: This study suggests that PTSD may have a negative impact on the couple's relationship and the parent-baby bond.