Case Study: How Do Residents Transition Between Their Care Home and The Emergency Department?

Arnold, M (2026) Case Study: How Do Residents Transition Between Their Care Home and The Emergency Department? Doctoral thesis, Liverpool John Moores University.

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Abstract

Background: Transitions between care homes and emergency departments are clinically, ethically, and logistically complex. Existing literature has focused on adverse outcomes, communication failures, and systemic fragmentation, but often neglects the lived experiences and ethical dimensions shaping these transitions.

Study aim: To investigate how residents transition between their care homes and emergency departments in England.

Methodology: A single embedded case study design, informed by Yin’s (2018) methodology and aligned with a constructivist epistemology, was used to examine this healthcare process. Embedded units were defined as individual transitions. Data were collected by interviews with care home and emergency department staff, residents and relatives in addition to non-participant observations in practice. Documentary analysis completed the dataset and enabled triangulation across sources, allowing for the exploration of the topic at hand through multiple lenses.

Main findings: Two sets of themes were identified. Structural themes related to communication, resident and relative involvement in decision-making, and staff attitudes and skills. Constructed ethical themes of autonomy, capacity, veracity, fidelity, and power emerged inductively across embedded units. Autonomy was often constrained by institutional routines and assumptions about capacity. Capacity was inconsistently assessed and interpreted, particularly in time pressured environments. Veracity reflected the accuracy, completeness, and reliability of information exchanged during transition and was frequently compromised. Fidelity emerged as a relational and ethical commitment to resident centred care, often disrupted during transition. Power operated subtly through documentation practices, professional hierarchies, and systemic processes.

Conclusions: This study extends existing research by offering a theoretically informed account of the ethical, relational, and organisational dimensions of transitions between care homes and emergency departments. Findings suggest that transition quality is not only a procedural matter but deeply shaped by how autonomy and capacity are interpreted, how veracity and fidelity are enacted, and how power influences processes within institutional structures. Drawing on these insights, the study provides evidence-informed recommendations to strengthen transitional care, including guidance for digital and AI-enabled systems.

Item Type:	Thesis (Doctoral)
Uncontrolled Keywords:	care homes; emergency departments; care transitions; older people; autonomy; case study research; communication; decision-making
Subjects:	R Medicine > RT Nursing
Divisions:	Nursing and Advanced Practice
Date of acceptance:	14 May 2026
Date Deposited:	09 Jun 2026 12:38
Last Modified:	09 Jun 2026 12:39
DOI or ID number:	10.24377/LJMU.t.00028707
Supervisors:	Hayes, JA, Kane, R and Leavey, C
URI:	https://researchonline.ljmu.ac.uk/id/eprint/28707

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