UBC Theses and Dissertations
Nurses' experiences of caring for the older adult in the emergency department Taylor, Bonny Joyce
The population of those over the age of 65 continues to grow. This cohort is one of the largest consumers of health care and presents with some unique needs and challenges. In a health care environment with fewer family physicians and careful resource allocation many older adults must seek health care in the emergency department (ED). Compared to younger cohorts older adults spend more time in the ED, require more diagnostic tests and are more often admitted and held in the ED until an inpatient bed becomes available. This changing demographic has an impact on ED nurses who must straddle care for incoming emergency patients and boarded inpatients. As the older adult population continues to grow it is important to understand nurses’ experiences of caring for the older adult in this unique venue. This ethnographic study used semi-structured interviews and non-participant observation, to understand nurses’ experiences of caring for older adults in the ED. Seven registered nurses participated in the interview process and detailed their experiences of caring for the older adult in the ED. Interviews were conducted at locations of the nurse’s choice. Data was transcribed verbatim and analyzed thematically. Three themes emerged from the findings: the culture of the ED which focused on priority setting and throughput of patients, fit and lack of fit between the older adult and the ED, and managing lack of fit. Nurses relied on a default orientation of priority setting but recognized this put the older adult at risk of ‘under care’, prolonged length of stay in hospital, and increased risk of mortality and morbidity. The findings of this study have implications for nursing practice, education, and research. ED nurses need to be aware of the needs and the challenges of caring for the older adult in the ED. ED nurses need education on the atypical presentation of older adults to the department. Further research is needed to investigate and develop innovative models for health care delivery for the older adult in the ED. Health care administration needs to look at different models of care delivery for the older adult in the ED.
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