'I've got to go in there with my armour on': Adverse Childhood Experiences Among Adults Who Frequently Attend Emergency Departments.

Vicki Binnie, Melanie Jessup, Robyne Le Brocque, Amy N B Johnston
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Abstract

Frequent presentations to emergency departments contribute to increased service demands and healthcare costs. Literature suggests these adult presentations may be influenced by childhood adversity. This qualitatively driven, mixed methods study explored the self-perceived role of childhood adversity in the health of adults who frequently attended Australian Emergency Departments and their perceptions of the healthcare they received. Data were collected using validated instruments and semi-structured interviews with 12 purposefully sampled adults who frequently attended emergency departments. Qualitative data were analysed using interpretive phenomenological analysis. Three major themes were identified-The experience of childhood adversity: articulating challenges related to childhood trauma, and the subsequent impacts on participants' health, behaviours, relationships and sense of control; Pursuing safety: exploring action participants took to keep themselves and others safe, with this requirement extending into adulthood and influencing Emergency Department presentations; and Seeking humanising healthcare: identifying challenges participants experienced while seeking care in the Emergency Department. Participants perceived their mental health to be profoundly affected by their past experiences of trauma, leaving them feeling vulnerable at times and more likely to experience re-traumatisation in the Emergency Department. Feelings of stigmatisation during Emergency Department encounters led participants to employ self-protection strategies creating further barriers to recovery. Participants described Emergency Departments as often failing to comprehensively address their healthcare needs. They offered suggestions for more effective care interventions. Findings highlight the need for further research to inform policy and practice when designing and implementing interventions for these adults. Consolidated Criteria for Reporting Qualitative Research (COREQ) guided study reporting.

我得穿上盔甲进去":经常去急诊科就诊的成年人的不良童年经历。
经常到急诊科就诊会增加服务需求和医疗成本。文献表明,这些成年人的就诊可能受到童年逆境的影响。这项定性的混合方法研究探讨了经常到澳大利亚急诊科就诊的成年人对童年逆境在其健康中所起作用的自我认知,以及他们对所接受的医疗保健服务的看法。研究使用经过验证的工具和半结构式访谈收集数据,有目的地抽取了 12 名经常去急诊科就诊的成年人。定性数据采用解释现象学分析法进行分析。我们确定了三大主题--童年逆境的经历:阐明与童年创伤有关的挑战,以及随后对参与者的健康、行为、人际关系和控制感产生的影响;追求安全:探索参与者为保证自己和他人安全而采取的行动,这一要求一直延续到成年并影响到急诊科的就诊;以及寻求人性化的医疗服务:确定参与者在急诊科寻求医疗服务时遇到的挑战。参与者认为他们的心理健康受到过去创伤经历的严重影响,使他们有时感到脆弱,更有可能在急诊科再次遭受创伤。在急诊科就诊时,被污名化的感觉导致参与者采取自我保护策略,这进一步阻碍了他们的康复。据参与者描述,急诊科往往不能全面满足他们的医疗保健需求。他们建议采取更有效的护理干预措施。研究结果突出表明,在为这些成年人设计和实施干预措施时,有必要开展进一步的研究,为政策和实践提供依据。定性研究综合报告标准》(COREQ)为研究报告提供了指导。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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