Older People In Acute Settings Research Articles

An innovative approach to hydration for a patient with dementia.

Nursing older people in acute settings involves the provision of complex care, including the maintenance of good hydration. Dehydration is a serious condition that may contribute to the development of pressure ulcers, urinary tract infections, acute kidney injury and venous thromboembolism. If oral hydration methods are not successful, the alternatives are intravenous (IV) or subcutaneous fluid hydration therapy. These are invasive methods and may not be tolerated by all patients. This article uses a case study to explore an innovative approach to oral hydration. The intervention was developed for Roy, a patient with advanced Alzheimer's disease, who had a reduced fluid intake and who became agitated when staff or family members attempted to assist him with nutrition and hydration. It involved consultation with Roy's family and the introduction of a flavoured drink to encourage the patient to drink. His weekly fluid intake doubled as a result and the intervention avoided the use of alternative invasive rehydration therapy. Although this was a local initiative developed for one patient, it is an example of how a person - entred, collaborative approach can have a positive effect for patients.

‘Poppets and parcels’: the links between staff experience of work and acutely ill older peoples’ experience of hospital care

Few empirical studies have directly examined the relationship between staff experiences of providing healthcare and patient experience. Present concerns over the care of older people in UK acute hospitals - and the reported attitudes of staff in such settings - highlight an important area of study. AIMS AND OBJECTIVES. To examine the links between staff experience of work and patient experience of care in a 'Medicine for Older People' (MfOP) service in England. A mixed methods case study undertaken over 8 months incorporating a 149-item staff survey (66/192 - 34% response rate), a 48-item patient survey (26/111 - 23%), 18 staff interviews, 18 patient and carer interviews and 41 hours of non-participant observation. Variation in patient experience is significantly influenced by staff work experiences. A high-demand/low-control work environment, poor staffing, ward leadership and co-worker relationships can each add to the inherent difficulties staff face when caring for acutely ill older people. Staff seek to alleviate the impact of such difficulties by finding personal satisfaction from caring for 'the poppets'; those patients they enjoy caring for and for whom they feel able to 'make a difference'. Other patients - noting dehumanising aspects of their care - felt like 'parcels'. Patients are aware of being seen by staff as 'difficult' or 'demanding' and seek to manage their relationships with nursing staff accordingly. The work experiences of staff in a MfOP service impacted directly on patient care experience. Poor ward and patient care climates often lead staff to seek job satisfaction through caring for 'poppets', leaving less favoured - and often more complex patients - to receive less personalised care. Implications for practice. Investment in staff well-being and ward climate is essential for the consistent delivery of high-quality care for older people in acute settings.

Facing the future.

NURSES CARING for older people in acute settings will face challenges as the population ages, the drive to move care to the community continues and pressure to make services more cost effective is heightened by the recession.

Issues impacting on registered nurses providing care to older people in an acute care setting

The worldwide phenomenon of ageing populations in developed countries has led to an increased emphasis on how best to meet the healthcare needs of people aged 65 years and older. One area identified as requiring particular attention is the care provided to older people in acute settings. This paper reports on the findings of an exploratory qualitative study that investigated issues having an impact on registered nurses' ability to care for older people in a publicly funded teaching hospital in Australia. Issues identified pertain to the complexity of managing the healthcare needs of the older person with an acute illness; the acute care environment as being problematic for the older person, and maintaining continuity of care in an often fragmented and under-resourced healthcare system. It is clear from the study findings that registered nurses in the acute setting play a central and pivotal role in the multidisciplinary team caring for older people with regard to the management and coordination of care as well as in the provision of direct care. However, tensions arise from the curative focus dominant in acute care settings, which privileges and resources technically focused acute care skills and does not place as high a priority on developing appropriate knowledge, attitudes and skills specific to the care of older people. The findings provide a base from which to progress further research as well as a challenge to those working in acute settings to develop systems of care that maximise the role of the registered nurse in improving outcomes for hospitalised older people.

The care of older people with a delirium in acute care settings.

This article suggests that nurses should play a major part in the screening, assessment and management of delirium in older people in acute settings.

Caring for older people in acute settings: Lessons learned from an action research study in accident and emergency

The health and social care of older people has never been so high on the political agenda. In particular, there has been growing concern about the care of older people in acute settings. This paper reports the findings of an action research study which explored the organisation of care for older people in an accident and emergency (A&E) setting. Although the findings cannot be generalised directly to all acute settings, the action research methodology generated unique exploratory data, which suggest older patients arrive at hospital with low expectations of care and appear to understand many of the constraints under which staff are working. However, while patients appear to be able to identify small ways in which care could be improved easily, staff instead appear to blame the wider organisation for poor care and give the impression of being disempowered to care. This is despite findings which suggest nurses could make changes in the priorities they give to different aspects of care. The lessons learned from this action research study suggest that nurses may need to work more closely together to foster the much-needed improvements in care of older people. With the National Service Framework for Older People on the horizon, nurses cannot afford to ignore the needs of such a significant group of patients under their care.