Degree Name

Doctor of Philosophy


Graduate School of Public Health


The aim of this research was to study the thoughts and feelings of nursing staff towards primary care patients seeking treatment in emergency departments rather than visiting a General Practitioner in the community. Anecdotal information and information gained from literature suggested that there are very negative feelings towards patients who use the emergency care services for minor problems. This appears to have been an unresolved problem since at least the middle of the 19* century when writers commented negatively on this practice of people attending hospitals. Importantly, for contemporary nursing practice, these thoughts and feelings may have implications for the care received by patients.

Grounded Theory was used to direct the collection, organisation and the analysis of the data. The methods included participant observation, interviews and the administration of a questionnaire. The theory of social representation, originally developed by Moscovici in 1961, was used to determine, describe and analyse the thoughts and feelings of nursing staff towards primary care patients attending emergency departments. This allowed a more complex and dynamic picture to emerge which substantially enhanced the findings of previous studies.

The study was a comparative one between nursing staff in Australia and France. Are the thoughts and feelings of emergency nurses in other parts of the developed world towards primary care patients similar to those of English speaking countries, or do history, language and culture lead to different ideas and ways of dealing with primary care patients? Social representation theory was originally developed in France, though it has also been used in research in many variations of social research so it was an appropriate way to compare the contrast the thoughts and feelings of the two groups of nurses in a consistent way. It was found, despite differences in organization and culture, that emergency nurses in France and Australia have remarkably similar thoughts and feelings towards primary care patients. The model of social representation was able to evaluate why this is so.

The results indicate that the thoughts and feelings of the staff in both countries are changeable and inconsistent; sometimes they are negative, as other studies have shown, but sometimes they are more positive, acknowledging the social and community roles of the emergency departments. The model of social representations, which this study develops, is able to show that many incoming stimuli go towards the thoughts and feelings of the staff at any one time. The final pathway of thought is influenced not only by the social conditioning of the individual, and the individual's cognitive make-up, but also by environmental inputs. The strengths of the incoming stimuli at any one time are the determinants of the thoughts and feelings of emergency nursing staff towards primary care patients.

The thesis concludes with a discussion of the roles of the emergency department and the educational needs of emergency staff The effective management of primary care patients is of great importance and it is hoped that the comparative findings will lead to fruitful developments in management techniques and policy.

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Unless otherwise indicated, the views expressed in this thesis are those of the author and do not necessarily represent the views of the University of Wollongong.