Description

INHospital Study: Do older people, carers and nurses share the same priorities of care in the acute aged care setting?

LOUISE D HICKMAN

School of Nursing, The University of Notre Dame, Broadway, NSW, Australia

PATRICIA M DAVIDSON

Centre of Cardiovascular and Chronic Care, School of Nursing and Midwifery, University of Technology Sydney and Curtin University, Sydney, NSW, Australia

ESTHER CHANG

School of Nursing, University of Western Sydney, Penrith, NSW, Australia

LYNN CHENOWETH

Aged and Extended Care Nursing, University of Technology Sydney; South Eastern Sydney- Illawarra Area Health Service, Sydney, NSW, Australia

ABSTRACT

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. Semistructured 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.

Keywords: quality of care, older person, patient satisfaction, nurses, acute care