Nurse–patient encounters in the hospital ward, from the perspectives of older persons: an analysis using the Authentic Consciousness Framework

Abstract

Person-centred strategies must enhance the capacity of not only older patients and their ability to assert self, but also the capacity of their nurses. Nurses must work to actively recruit the patient in all decision making.

Delivering dignified care: A realist synthesis of evidence that promotes effective listening to and learning from older people's feedback in acute care settings

“…Existing evidence is consistent in showing that person‐centred care embraces the formation of a therapeutic relationship between nurses, older patients and their care partners (McCormack & McCance, ). However, acute care delivery is often dominated by routine practices with minimal attention given to the older person's beliefs, values and priorities for care, which underpin investment in person‐centred relationships (Mitchell & McCance, ). Reasons for this are explored in more detail in the next synthesis.…”

“…Lack of nursing availability causes anxiety to both patients and relatives (Bridges et al., ). A study by Mitchell and McCance () found that in hospital, a culture of “not wanting to bother the busy nurse” had developed which also hindered the opportunity for relationship‐ building. The likelihood of engagement between patient and nurse is therefore diminished by organisational context and cultural mechanisms affecting nursing availability.…”

“…Asymmetry in the relationship of older people with nurses is manifested in nurses’ use of negative communication styles, which serve to objectify and control, and which promote passivity and dependency. Nurses may not work as equal partners with older people and tend to be paternalistic in information‐sharing and decision‐making processes (Mitchell & McCance, ). Power differentials in relationships affect how communication will proceed (Lagacé et al., ) and can be discerned in the reluctance of older people to complain or provide negative feedback about care, possibly for fear of retribution.…”

“…A prerequisite for relational practice is the desire and motivation of nurses to engage in this process. However, as noted, nurses are sometimes neither visible nor present, which limits opportunity for social or therapeutic interaction (Bridges et al., ; Mitchell & McCance, ). Bridges et al.…”

How do clinicians practise the principles of beneficence when deciding to allow or deny family presence during resuscitation?

“…There has been an increasing focus in recent decades on family‐centred care and patient participation in health care, which includes shared decision‐making (World Health Organization (WHO) ). Yet clinicians continue to make decisions on behalf of patients and families in an attempt to do “what's best” (Campbell et al., ; Mitchell & McCance, ). Paternalistic decision‐making has been evident over many decades in relation to restricting family access to their hospitalised loved ones to “protect” them from potential harm.…”