Nurses' experiences of caring for the older adult in the emergency department: A focused ethnography (original) (raw)

Care of the Older Adult in the Emergency Department: Nurses Views of the Pressing Issues

The Gerontologist, 2013

The purpose of the study was to describe nurses' views of the issues to be addressed to improve care of the older adult in the emergency department (ED). Design and Methods: An exploratory content analysis examined the qualitative responses of 527 registered nurses from 49 U.S. hospitals who completed the Geriatric Institutional Profile. Results: 5 central themes emerged from the analysis, representing a lack of older personhospital environment fit in the ED: (a) respect for the older adult and carers, (b) correct and best procedures and treatment, (c) time and staff to do things right, (d) transitions, and (e) a safe and enabling environment. The nurses offered solutions to address lack of fit, including modifications to the social climate, policies and procedures, care systems and processes, and physical design. Implications: The nurses' descriptions of the pressing issues surrounding care of older adults in the ED provide useful information to consider when developing a senior-friendly ED. Results also illuminate solutions that can be taken to address issues. These solutions give direction for future intervention research.

Emergency department nurses’ perceptions and experiences of providing care for older people

Nursing & Health Sciences, 2014

Emergency department nurses are challenged to provide safe, quality care to older people; however, nurses' perceptions of their role and experiences are seldom investigated. This focus-group study investigated emergency department nurses' perceptions and experiences of caring for older people, using four focus groups of nurses with a minimum three months' experience in the emergency department and a demographic survey. Data were thematically analyzed. Two themes emerged. The first was the clash of expectations between nurses and family/carers related to safety and quality of nursing care. Older people were perceived to be vulnerable in the emergency department, and nurses were frustrated that competing priorities decreased their ability to ensure them safe and quality care. Nurses felt family/carers were disappointed with care provided, and might not empathize with or understand their predicament. The second theme concerned nurses' perception that family/carers could provide a safety net for the older person in the emergency department in times of high workload. Nurses need support to care for older people in the emergency department to ensure safe and optimal care, and a shared understanding of care provision between nurses and family needs development.

Nurses' experiences and expectations of family and carers of older patients in the emergency department

2014

Background: Older people are often accompanied by family/carers to the emergency department (ED). Few studies investigate nurses' experiences of interacting with these family/carers. Aim: This study was an exploration of the experiences and expectations that ED nurses have of family and carers accompanying the older adult patient. Method: Focus group interviews (four, n = 27) were conducted and interviews were audio-taped, transcribed and then thematically analysed. Results: Three themes emerged relating to the way nurses judged family/carers of the older person, with the main theme the importance of time. Family/carers were evaluated as supportive and helpful when they saved nurses time and demanding and obstructive when they cost nurses time. A second theme was the family/carer as a knowledge resource. Nurses evaluated family/carers according to whether they could provide timely and useful information on the older patient. The third theme centred on nurses' evaluations of family/carers getting in the way of assessing or treating the patient, by their physical presence and demands and by limiting open communication with the patient. Conclusion: Emergency nurses have clear expectations of older patients' families and/or carers. Future research must determine how nursing roles can sustain positive interactions with older patients' families and/or carers in the ED.

Elderly care in the emergency department: an integrative review

Revista Brasileira de Geriatria e Gerontologia, 2018

Objective: To identify the care practices of nurses for the elderly in emergency departments. Method: An integrative review was carried out in the CAPES database, selecting publications in English, Portuguese and Spanish published between January 2011 and October 2016. The descriptors used were: "Emergency nursing"; "Geriatric nursing"; "Health services for the elderly"; "Elderly person"; "Nursing care". Results: Sixteen articles were analyzed in English, the majority of which had a qualitative approach (56.2%). Australia had the largest number of publications (31.2%). After reading the studies in full, the common themes were organized and classified into three categories: Challenges/difficulties in the care of the elderly in the emergency department, Positive experiences of elderly care in the emergency department and The emergency department as a space of death and dying. Conclusion: The care practices of nurses are focused on iden...

Determining emergency physicians' and nurses' views concerning older patients: a mixed-method study

International Emergency Nursing, 2014

The number of elderly patients presenting to emergency services is gradually increasing. Given that the needs of older patients differ from those of other patients, the quality of emergency care for this patient group also varies. This mixed-method study aimed to reveal the views of emergency service staff concerning ageing and elderly patients. Participants were 19 physicians and 17 nurses employed by the adult emergency service of a university hospital. Data were gathered using questionnaires and focus group interviews. Frequency and percentages were used to evaluate quantitative data. Open-ended questions used to gather quantitative data were analysed using thematic analysis and four themes (including understanding older patients' situations, good nursing care and medical treatment, affecting good nursing care and medical treatment, emotions experienced) were determined. Emergency department staff identified older patients as dependent individuals requiring health care. Nurses indicated that good care for older patients included ensuring that their physical, social, and psychological needs were met; whereas, physicians identified good treatment as improving the quality of life. Impediments to the care and treatment of older patients were identified as staff shortages, emergency service crowding, and lack of proper training for emergency department staff. Emergency department staff also indicated that they experienced weariness and exhaustion while providing health care for older patients. Emergency nurses and physicians were aware of older patients and their needs but experienced difficulties regarding patient density, physical settings, staff shortages, and a lack of training.

Factors to improve quality for older patients in the emergency department: a qualitative study of patient trajectory

BMC Health Services Research

Background Managing older people in the emergency department remains a challenge. We aimed to identify the factors influencing the care quality of older patients in the emergency department, to fine-tune future interventions for older people, considering the naturalistic context of the ED. Methods This is a qualitative study of some 450 h of observations performed in three emergency departments selected for their diverse contexts. We performed seventy observations of older patient trajectories admitted to the emergency department. Themes were extracted from the material using an inductive reasoning approach, to highlight factors positively or negatively influencing management of patient’s trajectories, in particular those presenting with typically geriatric syndromes. Results Four themes were developed: no geriatric flow routine; risk of discontinuity of care; unmet basic needs and patient-centered care; complex older patients are unwelcome in EDs. Conclusions The overall process of...

Improving care for older patients in the acute setting: a qualitative study with healthcare providers

PubMed, 2017

Background: The proportion of older people needing acute care is rapidly growing, thereby posing an increased burden on the acute care chain. The aim of this study is to gain more insight into the obstacles and potential improvement opportunities of the acute care process for older patients arriving at the hospital. Methods: Semi-structured interviews were conducted to determine the experiences of 18 different primary (i.e. general practitioner, community nurse) and secondary healthcare professionals (i.e. emergency department (ED) nurse, ED physician, geriatric physician, geriatric nurse, ambulance nurse, acute medical unit nurse), and three experts (2 researchers, 1 older adult advisor). Results: Four core themes emerged from the interviews: 1) The concept of frailty, awareness concerning frail older patients, and identification of frailty, 2) Barriers in the care process of older patients within the acute care chain, 3) Optimising the discharge process of older patients, and 4) Improvement opportunities suggested by the respondents. Early identification of frailty, improving the continuity of care by means of structured information exchange between care providers in the acute care chain, and a more generalist approach were considered important by the respondents in order to deliver appropriate care to older patients. Conclusion: This explorative study identified several barriers and improvement opportunities which are important to improve the quality, efficacy and appropriateness of the acute care of older patients. More seems needed in the future in order to share experiences, expertise and develop potential improvement strategies for the acute care of older patients.

Caring for Older People in Hospitals from the Perspective of Health Professionals: A Scoping Review

2021

A number of authors have raised questions concerning the quality of care and how older patients’ needs are met. Individual articles have generally sought to highlight any difficulties and deficiencies in caring for these patients [1-3]. Two factors in particular are addressed, namely the patient’s age and frailty. The findings and models of care presented in the literature and research projects can accordingly facilitate the developing of appropriate strategies and the allocating of resources to improve healthcare for older people [1-3]. As some authors point out, the quality of care for older people is a much broader concept than can by demonstrated by quantitative outputs such as morbidity and mortality [4-6]. In care for older people, the emphasis is not just on the quality and availability of healthcare, but also on other aspects of life such as values and religious beliefs, and human dignity and autonomy. A holistic and caring approach of carers is important, also as a support ...

Challenges and Barriers to Providing Care to Older Adult Patients in the Intensive Care Unit: A Qualitative Research

Open Access Macedonian Journal of Medical Sciences

BACKGROUND: Enhancing the quality of care for elderly patients needs an understanding of the challenges and obstacles experienced by the intensive care unit (ICU) staff in providing care. AIM: To explore the most challenging issues experienced by ICU staff, in particular, nurses, in the care of elderly patients in the general adult ICU. DESIGN: A qualitative research design was employed. The Standards for Reporting Qualitative Research (SRQR) were followed. METHODS: Based on theoretical sampling, we carried out 34 in-depth semi-structured interviews from two medical adult ICUs. Data analysis was carried out using qualitative conventional content analysis. RESULTS: Data analysis led to the identification of three interrelated categories and 12 subcategories. Three main categories were factors related to nurses’ attitude in elderly care, factors related to the system of care, and factors related to the models of patient care delivery. These categories came under the main theme of &quo...