Minimizing Strain: How Nurses Sustain Their Image as "Good Nurses"

Older adults are the population most likely to access healthcare due to an increasing incidence of chronic illnesses with age. As a result, nurses are managing the care of an older population within healthcare institutions which perpetuate societal ageist perspectives. Moreover, basic nursing education does not adequately prepare nurses to care for an aging population and little is known about how nurses are managing care of hospitalized older adults. A grounded theory study guided by symbolic interactionism examining a nursing perspective of caring for hospitalized older adults provides valuable insights into how nurses are practicing with an aging population. Nurses are prioritizing keeping their patients safe at all costs in institutions; they perceive the increased care requirements of older patients are under-recognized and inadequately resourced. To cope, they are re-defining nursing actions they perceive as morally distressing in order to preserve their image of themselves as “good nurses,” who are working within healthcare systems that are inadequately supporting them in providing what they define as “good care” to their older patients. Much can be learned about how to improve care of hospitalized older adults by listening to nurses’ perspectives about how healthcare systems are contributing to sub-optimal older adult care and engaging nurses in conversations about their nursing practices that are ethically distressing.