Factors Influencing Nurses’ Decision-Making in Transferring Nursing Home Residents to Emergency Departments: A Systematic Literature Review

Abstract Background This systematic literature review (SLR) explores factors influencing nurses’ decision-making when transferring nursing home residents (NHR) to emergency departments (ED). These decisions are pivotal to patient outcomes and highlight the need to enhance workforce capacity and capability within integrated care systems. Methods The SLR adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. An extensive search was conducted in December 2024 using Boolean logic-based search strings. Key databases, including PubMed, CINAHL, Google Scholar, and Medline, were utilized alongside hand-searching and snowballing techniques. The search yielded 32,490 papers published between 2020 and 2024. After applying inclusion and exclusion criteria, five relevant studies were identified and underwent critical appraisal. Results The thematic analysis of the five studies revealed five primary themes. They are Conflict with Key Stakeholders which illustrates that Nurses often navigated disagreements with other healthcare providers and family members. Family Involvement in Transfer Decisions as family expectations and preferences played a significant role in influencing nurses’ decisions. Unimplemented Advanced Care Directives (ACDs) as the absence of clear ACDs added complexity to decision-making. The Policy and Process Challenges as there was inconsistent policies and unclear processes which hindered efficient decision-making. Stakeholder Perception as nurses’ decisions were shaped by perceptions of other stakeholders, including ED staff and nursing home administrators. The same is illustrated below in a thematic map. Conclusion The findings underscore the complexity of nurses’ decision-making processes, shaped by dynamic interactions with stakeholders, policy constraints, and systemic factors. Addressing these challenges requires investment in workforce capacity and capability, particularly through training, interprofessional collaboration, and clearer policy frameworks.