Fundamental nursing actions for frail older people in the emergency department: A national cross‐sectional survey and a qualitative analysis of practice guidelines

Abstract

Aims To map how frailty among older people is assessed at Swedish emergency departments and to describe fundamental nursing care actions for these patients. Design Descriptive national survey and a qualitative analysis of text. Methods A majority (82%, n = 54) of the Swedish hospital‐based emergency departments for adults were included, representing all six healthcare regions. An online survey was used to collect data, together with submitted local practice guidelines for older people at the emergency departments. Data were collected during February–October 2021. Descriptive and comparative statistics were performed together with a deductive content analysis framed by the Fundamentals of Care framework. Results Sixty‐five per cent (35 of 54) of the emergency departments identified frailty, with less than half of them using an established assessment instrument. Twenty‐eight (52%) of the emergency departments have practice guidelines containing fundamental nursing actions for the care of frail older people. The majority of nursing actions in the practice guidelines were related to patients' physical care needs (91%), followed by psychosocial care needs (9%). No actions could be identified as relational actions (0%) according to the Fundamentals of Care framework. Conclusion Many Swedish emergency departments identify frail older people, but they use a range of different assessment instruments. While practice guidelines directing fundamental nursing actions for frail older people are often in place, a holistic, person‐centred view addressing the patient's physical, psychosocial and relational care needs is missing. Impact The population is growing older, and more people are needing more complex hospital care. Frail older people have an increased risk of negative outcomes. The use of a variety of assessment instruments for frailty may pose a challenge to equal care. To ensure a holistic, person‐centred view of frail older people, the Fundamentals of Care framework can be used in developing and reviewing practice guidelines. Patient or Public Contribution Clinicians and non‐health professionals were invited to review the survey to ensure face and content validity.

Frailty assessment tools in the emergency department: A geriatric emergency department guidelines 2.0 scoping review

“…Ekermo and colleagues 55 report that 52% of Swedish EDs have nursing care guidelines for frail elders, which include managing physical psychosocial needs during their ED care. Specifically, these care guidelines were aimed at skin and wound management.…”

“…Psychosocial interventions included managing anxiety, information needs, and reducing confusion. Ekermo et al 55 suggest that nursing guidelines for frail elders address both physical and psychosocial/relational needs.…”

“…Current evidence 57 has demonstrated the improvement of care for frail older adults with staffing initiatives, changes to the physical space of ED, or care delivery interventions is associated with improved health care utilization outcomes beyond the physical space and care trajectory of the ED. Specifically, nursing interventions may prove important to prevent in‐ED physical or psychological injury 55 …”

“…team in the ED was associated with a 33% relative increase in rate of discharge home. 54 Ekermo and colleagues 55…”

“…Current evidence57 has demonstrated the improvement of care for frail older adults with staffing initiatives, changes to the physical space of ED, or care delivery interventions is associated with improved health care utilization outcomes beyond the physical space and care trajectory of the ED. Specifically, nursing interventions may prove important to prevent in-ED physical or psychological injury 55. Further research needs to be done on (1) determining the usefulness of frailty identification in the very specific context of emergency care (identification of physiologic instability and appropriate stabilization); (2) the effects of care delivery interventions or educational initiatives for front-line medical professionals on patient-oriented outcomes, such as mortality and functional decline; and (3) ensuring the feasibility and acceptability of these initiatives for patients.…”