Care of acutely ill older patients in hospital: clinical decision-making

The aim of this study was to investigate the nursing care of older hospitalised patients and how the nurses providing care understood the clinical decision-making around this care.

One of the challenges confronting nurses is how best to manage the care required by increasing numbers of older people with complex problems and illnesses being admitted to hospitals.

This qualitative study used multiple methods of data collection that included observations, interviews and, where needed, review of the hospital records of older patients.

Twenty-seven registered nurses participated from across five hospital units. Data were analysed thematically to understand how nurses cared for older patients.

The interpretative analysis yielded three major themes that emerged in relation to nursing care of older patients: knowing about care; optionalising care; and blaming. Participants were knowledgeable and potentially competent in providing care required by older patients in hospital. However, they admitted that they optionalised care by making decisions about which patients to care for and how much care should be provided. Participants rationalised these decisions through laying blame on the hospital organisation, needing social time with colleagues and preferring medically oriented technical interventions.

Nurses experienced tension between professional and ethical nursing responsibilities and the lack of challenge and reward associated with the care of this group of patients. They attended to the more highly valued medical interventions and substituted time to care for older patients by socialisation with colleagues.

This study draws attention to the discrepancy between stated and practice values in the care of hospitalised older patients. Clarification of disciplinary values and the professional role is required, including the adoption of models of care that refocus nursing care through the promotion of holistic practices.