The findings suggest that nurses must acknowledge the lived experience of the persons cared for and they must seek out the meaning that patients ascribe to this experience to understand the situation and thus conduct interventions that meet the needs expressed.
Aim
To understand how family caregivers of older adults hospitalized for orthopaedic surgery are integrated by nurses in delirium prevention care.
Design
Multiple case study.
Methods
The sample consisted of eight cases. Each case comprised an older adult, a family caregiver, and a nurse. Data were collected from September 2017 ‐ April 2018 through various instruments, including semi‐structured interviews and family caregiver logs. Within‐ and across‐case analyses were conducted, based on the model of The Care Partner Engagement developed by Hill, Yevchak, Gilmore‐Bykovskyi, & Kolanowski (Geriatric Nursing, 35, 2014, 272).
Results
Two themes emerged: (a) family caregivers were engaged in caring for the older adults during their hospital stay, though they had differences in terms of views and needs; and (b) family caregivers communicated with nurses but nurses did not recognize their role and did not integrate them much in care.
Conclusion
The presence and availability of family caregivers, their sense of responsibility towards the hospitalized older adults, and their positive effects on them suggest that family caregivers could be integrated more systematically in a care partnership with nurses. Poor integration of family caregivers in delirium prevention care shows that nurse delirium prevention competencies and their relational skills for communicating effectively with family caregivers need to be developed further.
Impact
Integrating family caregivers in delirium prevention care for older adults is a challenge for nurses. Family caregivers are engaged during the hospitalization of older adults, though differences and problems exist between the two groups. While there is communication between patients, family caregivers, and nurses, nurses do not recognize the role of family caregivers and hardly integrated them in the delirium prevention care of hospitalized older adults. Nurses must adopt a patient‐ and family‐centred approach. Care and training facilities must make resources available to implement this approach in nursing practice.
Nurses must be trained in how to communicate with family caregivers in order to form a partnership geared to preventing complications in hospitalised older persons. Results could be used to inform policy regarding the care of hospitalised older persons.
Surgery unit nurses often deal with older people in an acute confusional state (ACS). To care for them, nurses must resort to different patterns of knowing, including empirical, esthetic, ethical, personal and emancipatory. According to Chinn and Kramer (2008), it is by consciously and deliberately asking themselves critical questions about specific clinical situations that nurses can enhance their knowledge and improve practice. In this regard, narrative pedagogy developed by Diekelmann (2001), which encourages sharing lived experiences and seeking other possibilities for the future, seems a well suited approach. This article presents the theoretical bases of narrative pedagogy and the grounds for an intervention inspired by this approach and intended for nurses who must care for hospitalized older people in an ACS. This innovative pedagogical intervention, which encourages nurses to participate actively in their learning, is consistent with recent empirical works on continuing education of health professionals.
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