Italian nurses' perception of the avoidability of problems affecting older people with multiple chronic diseases

The aim of this study was to discover whether problems experienced by older people with multiple chronic diseases were considered to be avoidable from the perspective of nurses.

The concept of avoidability is defined as 'that which can be avoided'; when something is perceived as avoidable, action is taken 'to prevent the occurrence'. It is possible that the nurses' perception on the avoidability of problems in chronically-ill older people, could have a role in the decisions they make about the most suitable type of care (e.g. therapeutic, preventive) while if they perceive a problem to be unavoidable they adopt palliative interventions. No literature is available on the factors that nurses take into account when judging whether a patient's problem could be avoided or not, and no nursing diagnosis title includes the concept of an 'unavoidable' problem (e.g. unavoidable depression related to nursing home institutionalisation).

A phenomenological method was used to identify and understand the meaning of a human being's experience by means of direct reporting and interviews.

Participants were forty 40 nurses working in homecare services and nursing homes in Northern Italy.

Various factors were assumed to make certain problems inescapable, such as the interaction of multiple diseases, older people refusing care and inadequate surveillance. Other problems were judged to be completely or partially avoidable such as aspects relating to families' reactions (the burden of providing care, family members' inability to provide adequate care), and to healthcare management dysfunctions (poor exchange of information, limited resources).

The nurses perceived they could only marginally modify the older person's problems however, they could take action instead to improve the organisational processes, the involvement of family members, and their own skills and sense of purpose.

To reflect on unavoidable nursing problems and related factors is important for the potential consequences of clinical judgment on patients and on nursing care and for ethical implications. The factors affecting avoidable or unavoidable problems need strategic and individualised action to develop healthcare plans including the older people themselves, their families, and members of a multidisciplinary team and to provide adequate resources and educational programmes.