Nursing care of older patients in hospital: implications for clinical leadership

Abstract

Objective: This study investigated how nurses managed the care of acutely ill older patients in acute hospital settings. Design: Constructivist inquiry has been used that included multiple methods of data collection: interviews, observations and documentation of care. Setting: Participants were recruited from five acute medical and surgical units across two public hospitals. Participants: Twenty seven registered nurses caring for patients who were aged 65 years and older. Results: Three themes were identified from the data analysis: being informed about care; limiting care; and rationalising actions. Nurses articulated they understood that quality care was important, but care was limited and interventions were prioritised. The participants blamed health services, lack of clinical leadership, patients, other nurses, and themselves. Conclusion: These findings have implications for issues of professional agency and clinical leadership. While there is a need for good clinical leadership which is aligned with empowerment to exercise professional agency, speculation about how the dynamics within the units in this study developed and were maintained needs further consideration.