INHospital study: Do older people, carers and nurses share the same priorities of care in the acute aged care setting?
The aim of the INHospital study was to compare the level of importance of care priorities and satisfaction levels with care among patients, carers, and nurse caregivers in the acute aged care setting. The INHospital study used sequential mixed methods approach for data collection. Survey data was completed within five metropolitan acute aged care wards on patients (n = 78), their carers (n = 45) and nurses (n = 37). The caring activity scale (CAS) survey was administered to participants in order to determine and compare the perceptions of the importance and satisfaction of care. Semi-structured interviews of patients (n = 7) and carers (n = 7) were conducted after completion of the CAS survey. This qualitative data aimed to probe more deeply into the patient's and carer's care priorities and satisfaction as measured in the CAS.
The CAS data demonstrated that patients, carers and nurses rated implementing, observing and reporting doctor's orders similarly, while differences between groups were observed in relation to prioritising physical and psychosocial care and discharge. There were significant differences between patients, carers and nurses on overall importance (p = 0.001) and satisfaction with respect to nursing care (p = 0.001). Qualitative data generated five themes (1) Nurses doing the best they can in challenging circumstances; (2) Achieving a balancing act in a pressured environment; (3) Striving to maintain and sustain independence; (4) The discharge process: not a shared priority; and (5) Challenges of the carer role.
A key implication of this study is the incongruence between what patients consider a priority for care and the priority ascribed to those tasks by nurses. Qualitative findings added depth to the survey data and qualified responses by confirming that patients thought that nurses did the best they could within a culture of busyness, while patients strived to maintain and sustain their own independence. However, the themes of managing the discharge process and carer burden arose mainly from the carer semi-structured interviews.
Louise D Hickman
Director, Postgraduate Nursing Studies, Faculty of Health, University of Technology Sydney, Broadway, NSW
Patricia M Davidson
Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology, Sydney, Broadway, NSW; St Vincentís and Mater Health, Sydney, NSW; Dean, Johns Hopkins University School of Nursing, Baltimore, MD, United States of America
School of Nursing, University of Western Sydney, Penrith NSW
Faculty of Nursing and Midwifery and Health, University of technology Sydney, NSW
Access Economics (2006). Dementia in the Asia Pacific region: The epidemic is here. Asia Pacific members of Alzheimer's Disease International Canberra: Access Economics.
Andrew, S., & Halcomb, E. J. (2006). Mixed methods research is an effective method of enquiry for working with families and communities. Contemporary Nurse (Advances in Contemporary Nursing), 23, 145-153.
Andrew, S., & Halcomb, E. J. (2007). Mixed method research. In S. Borbasi & D. Jackson (Eds.), Navigating the maze of nursing research: An interactive learning adventure (2nd ed.). Marrickville, NSW: Elsevier.
Andrew, S., & Halcomb, E. J. (Eds.). (2009). Mixed methods research for nursing and the health sciences. London: Wiley-Blackwell.
Andrew, S., Salamonson, Y., & Halcomb, E. J. (2008). Integrating mixed methods data analysis using NVivo©: An example examining attrition and persistence of nursing students. International Journal of Multiple Research Approaches, 2, 36-43.
Asplund, K., Gustafson, Y., Jacobsson, C., Bucht, G., Wahlin, A., Peterson, J., Blom, J. O., & Angquist, K. A. (2000). Geriatric-based versus general wards for older acute medical patients: A randomized comparison of outcomes and use of resources. Journal of the American Geriatrics Society, 48, 1381-1388.
Attree, M. (2001). Patients' and relatives' experiences and perspectives of 'good' and 'not so good' quality care. Journal of Advanced Nursing, 33, 456-466.
Australian Department of Health and Ageing. (2005). Canberra: Commonwealth of Australia.
Australian Department of Health and Ageing. (2006). Department of Health and Ageing Factbook 2006. Canberra: Commonwealth of Australia.
Australian Institute of Health and Welfare. (1999). Australian Hospital Statistics 1997-1998. Canberra: Australian Institute of Health and Welfare.
Australian Institute of Health and Welfare. (2006). Australia's Health 2006. Canberra: Australian Institute of Health and Welfare.
Bazeley, P., & Richards, L. (2000). The NVivo qualitative project book. London: Sage.
Buchanan, J., & Considine, G. (2002). Stop telling us to cope! A report for the NSW Nurses Association. Sydney: Australian Centre for Industrial Relations Research and Training, University of Sydney.
Chang, E., Hancock, K., Chenoweth, L., Jeon, Y., Glasson, J., Gradidge, K., & Graham, E. (2003). The influence of demographic variables and ward type on elderly patients' perceptions of needs and satisfaction during acute hospitalization. International Journal of Nursing Practice, 9, 191-201.
Clarke, A., Hanson, E. J., & Ross, H. (2003). Seeing the person behind the patient: Enhancing the care of older people using a biographical approach. Journal of Clinical Nursing, 12, 697-706.
Cockrell, J., & Folstein, M. F. (1988). Mini mental state examination (MMSE). Psychopharmacology Medicine, 24, 689-682.
Courtney, M., Tong, S., & Walsh, A. (2000). Acute-care nurses' attitudes towards older patients: A literature review. International Journal of Nursing Practice, 6, 62-69.
Duffi eld, C., & O'Brien-Pallas, L. (2003). The causes and consequences of nursing shortages: A helicopter view of research. Australian Health Review, 24, 186-193.
Folstein, M., Folstein, S., & Mchugh, P. (1975). Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189-198.
Halcomb, E. J., & Andrew, S. (2005). Triangulation as a method for contemporary nursing research. Nurse Researcher, 13, 71-82.
Hancock, K., Chang, E., Chenoweth, L., Clarke, M., Carroll, A., & Jeon, Y. (2003). Nursing needs of acutely ill older people. Journal of Advanced Nursing, 44, 507-516.
Hart, B., Birkas, J., Lachmann, M., & Saunders, L. (2002). Promoting positive outcomes for elderly persons in the hospital: Prevention and risk factor modification. Advanced Practice in Acute Critical Care, 13, 22-33.
Hickman, L., Newton, P., Halcomb, E. J., Chang, E., & Davidson, P. (2007). Best practice interventions to improve the management of older people in acute care settings: A literature review. Journal of Advanced Nursing, 60, 113-126.
Hickman, L. D., Rolley, J. X., & Davidson, P. M. (2010). Can principles of the chronic care model be used to improve care of the older person in the acute care sector? Collegian, 17, 63-69.
Higgins, L., Fiveash, B., Parker, V., Lay, J., Rutter, S., Wamsley, R., Narcarrow, M., & Henderson, D. (1997). The experiences of elderly people during acute hospitalisation. Geriaction, 15, 13-19.
Hudson, K., & Sexton, D. (1996). Perceptions about nursing care: Comparing elders' and nurses' priorities. Journal of Gerontological Nursing, 22, 41-46.
Johnson, J. (1987). Selected nursing activities for hospitalised clients. Journal of Gerontological Nursing, 13, 29-33.
Jones, J., & Cheek, J. (2003). The scope of nursing in Australia: A snapshot of the challenges and skills needed. Journal of Nursing Management, 11, 121-129.
Landefeld, C., Palmer, R., Kresevic, D., Fortinsky, R., & Kowal, J. (1995). A randomized trial of care in a hospital medical unit especially designed to improve the functional outcomes of acutely ill older patients. New England Journal of Medicine, 332, 1338-1344.
Minichiello, V., Madison, J., Hays, T., & Parmenter, G. (2004). Doing qualitative in-depth interviews. In V. Minichiello, G. Sullian, J. Greenwood, & A. Axford (Eds.), Research methods for nursing and health science. French's Forest, NSW: Prentice Hall Health.
NSW Health. (2000). Health working as a team - The way forward. NSW Government Action Plan for Health - Bulletin #3.
NSW Health. (2004-2006). Framework for integrated support and management of older people in the NSW health care system. Sydney: NSW Health.
Patton, M. Q. (2002). Qualitative research & evaluation methods. Thousand Oaks, CA: Sage.
Pudelek, B. (2002). Geriatric trauma: Special needs for a special population. AACN Clinical Issues, 13, 61-72.
Reed, J., & Clarke, C. (1999). Nursing older people: Constructing need and care. Nursing Inquiry, 6, 208-215.
Reedy, L., & Bragg, R. (2000). Earlier discharge [issues paper]. Sydney: Council of Social Service of NSW & NSW Community Health Association.
Reuben, D. (2000). Making hospitals better places for sick older persons. American Geriatrics Society, 48, 1728-1729.
Rich, M. (2001). Heart Failure in the 21st century: A cardiogeriatric syndrome. Journals of Gerontology Series A Biological Sciences & Medical Sciences, 56, M88-M96.
Sarantakos, S. (2005). Surveys: Interviewing. In S. Sarantakos (Ed.), Social research (3rd ed.). New York: Palgrave Macmillan.
Seidman, I. (1998). Interviewing as qualitative research. New York: Teachers' College Press.
Victorian Government. (2005). Improving hospital care of people with dementia. Melbourne: Aged Care Branch, Victorian Government.
White, M. (1972). Importance of selected nursing activities. Nursing Research, 21, 4-14.
World Health Organization. (2004). Building blocks for action innovative care for chronic conditions: Global report 2002. Geneva: WHO.
quality of care; older person; patient satisfaction; nurses; acute care
PP: 076 - 088