Perceptions of factors that impact on the practice of acute care Victorian nurses, in response to an aging society: an exploratory descriptive study.

摘要

Background In Australia the future direction of healthcare delivery is driven by the demands of a rapidly increasing aged population. The healthcare systems response requires expertise, leadership and resources for progressively multiple and complex aged healthcare needs. The nursing skills, knowledge and attitudes required to meet these needs include: the ability to undertake comprehensive geriatric assessments, clinical teaching, family and caregiver support, mental health assessments, specific research, leadership capabilities and service development. Aims of the Research The aim of this research is to explore the factors perceived by registered nurses (RNs) and enrolled nurses (ENs) that impact on the care provided to an increasingly aged population of patients in an acute care setting from one metropolitan hospital. Two research questions informed this study: 1. In the current clinical context, what are the factors that RNs and EN identify as impacting on their patient care? 2. What are the perceived challenges nurses face when caring for aged patients in the acute care setting? Method/approach This research was undertaken using qualitative methodology and an exploratory descriptive approach. Ten nurses (five RNs and five ENs) were recruited using a convenience sample from a Melbourne Metropolitan Acute Care Hospital and participated in qualitative interviews. Data collected was coded and thematically analysed. Findings Two distinct themes emerged to represent the perceptions of the nurses: Practice environment and preparedness for practice. The practice environment theme included factors that contributed to the organisational characteristics of a work setting that aid or constrain professional nursing practice. These factors were identified as patient centred care, older adults over 65, multiple co morbidities, polypharmacy, tasks/time/paperwork and “catching up”. Factors associated with preparedness for practice were identified as: assessment skills, feelings of inadequacy, increased anxiety, prioritisation, learning on the job and EN transition to practice. Conclusions The participants identified that their ability to provide patient centred care is being challenged by multiple factors impacting on the contemporary work environment. These factors led them to revert to a ‘task orientated’ approach to their practice, which resulted in less than optimal mode of patient care. An increasingly aged population increases the likelihood of polypharmacy and multiple co-morbidities increasing patient acuity and further challenging nurses’ ability to provide holistic patient care. The prioritisation of patient care and increased anxiety often associated with specific nursing clinical requirements often leads to nurses experiencing feelings of inadequacy. As nursing is considered an applied profession, the ability to continue to ‘learn on the job’ was highly valued by the nurse participants.