Understanding the experience of older people in acute health care
Irvine, L. (2008) Understanding the experience of older people in acute health care, no. 376.
An interest in older people's experiences of acute care and how they make sense of that experience was the starting point for this thesis. Using the epistemological base of social constructionism the thesis examines the experiences of care older people have within acute health care settings and explores the qualified nurse's experiences of care in relation to older people in the context of acute care. Thirteen patients and fourteen nurses from one hospital participated, through semi-structured interviews, in the study. Field notes were used to further illuminate the context of the research. Data was coded using an inductive coding approach, followed by a refining of categories through the use of concept mapping. Data analysis was undertaken manually and cross checking undertaken to establish clear findings. Patient's understandings and explanations of their care were identified, along with the nurse's views and accounts of care within an organisational context. Many factors were found to be influential in the older person's experience of care. Media coverage of care experiences, along with comparison of personal experiences affected the older person's view of their care experience. The impact of the organisational approach to acute care was seen as a major factor in the care experience from the patient and nurse perspective. Lack of a shared philosophy of care within the nurse population led to a lack of continuity and consistency of care for patients. Similarly differing perspectives on the nature of the patient – nurse relationship led to tensions within the care environment causing stress and de-motivation in the nurse population that ultimately affected the patient experience. A conceptual framework was developed that illustrated the complicity between patients and nurses to maintain the illusion of a caring nurse.