On a hidden game board: the patient's first encounter with emergency care at the emergency department

Aims and objectives. Describe and understand the patients first encounter in emergency care at the emergency department, as experienced by the patient, next of kin and first providers from different professions. Background. The emergency department is most often described as having high levels of satisfaction with the quality of care delivered. Although the patients appreciate clinical competence, quick assessment and technical skills, a close connection between patient satisfaction and vulnerability has been shown. Design. A lifeworld research perspective was used in four different situations at the emergency department. Methods. The data consisted of 14 open-ended interviews with patients, next of kin and first providers. Results. The analysis showed that narratives of the past, present and future characterises the encounter where mutual narratives form a foundation for those involved in the encounter. Five constituents further described the variations; vague rules and conflicting expectations in the encounter, an encounter with the biological body, courtesy encounters, isolated in a timeless encounter, striving for meaning in the encounter. Discussion. Instead of expecting the patients to know the unwritten rules of the emergency department, the first providers could give clear information about expected waiting times and what to expect in the encounter. The challenge is to make a meaningful comprehensible context for all involved which can be generated in the interpersonal encounter. Relevance to clinical practice. The findings highlight the importance of disclosing the rules of the game by means of giving clear information which would give possibilities for the patient to maintain control, for strengthening the nurses role as the patients advocate and for strengthening the effort for an emergency department to become more of a learning organisation.