The provision of care for older adults in the acute care setting
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Research indicates that the needs of older adults in acute healthcare settings are often not met. Various models of care, such as Person-Centred Care (PCC) which positions the individual at the centre of healthcare decisions, provide guidance for nurses and suggest various strategies to improve the quality of care. However, in older adult patients, PCC cannot be successfully implemented in an acute setting without exploring all the factors involved. Therefore, this dissertation sought to answer the research question: “What are the enablers and barriers to the delivery of PCC to the older adult (65 and over) in an acute hospital setting?” An interpretative post-positivist approach was used in conducting a thematic analysis and resulted in the identification of four main themes: experience of older adults in acute settings, models of care, ageism and attitudes, and nurse’s challenges. Barriers to care were identified and included those that reflected the older adult’s experience of physical care (e.g., lack of assistance with activities of daily living, lack of adequate pain management and age-unfriendly physical settings) and of relational care (e.g., poor verbal and non-verbal communication). Negative attitudes of nurses towards the older adults may also result in barriers to care and may be a reflection of the ethnic or cultural background of the nurse, or their lack of knowledge around caring for this patient group. Additionally, the increased challenges faced by nurses erect barriers to delivery of care such as a lack of time and resources, overwhelming patient loads, and lack of effective leadership, and organisational support. In contrast, the enablers of delivering quality care that are relevant to the patient’s experience included utilizing the client’s own knowledge, building respectful and empathic interactions and relationships with patients and family by carefully listening and communicating. The provision of a secure and emotionally safe physical environment also enhances the patient’s experience of care. Enablers that help to counteract negative attitudes of nurses include increased education around the needs of the older adults. Enablers that minimise the challenges nurses face include providing an aged friendly environment, adequate resources, a collaborative working environment, appropriate leadership, and organisational support. Although the original focus was on PCC, this review of literature indicated that introducing PCC into the acute ward setting was challenging and complex. In order to resolve these issues, a more co-ordinated approach may be required using elements of other models that encourage relational care. Such an approach will develop and sustain effective nursing leadership, promote and assist in the development of a healthy organisational culture, and support nurses to practice in the way that older adults indicate is their preference. Relational care models which are of significant for older adults have been identified. However, these models were developed based on research from countries other than New Zealand and their implementation within New Zealand hospitals may not be culturally appropriate. Therefore, there is a need to explore the perceptions of New Zealand older adults and nurses toward the cultural propriety of the recommendations of these models of care.