A qualitative descriptive study was undertaken to explore and describe experiences of nurses in assessing decision-making capacity of patients over age 65 years. The investigator was also interested in learning under what circumstances nurses seek health care decisions from a surrogate, what decisions are usually sought from a surrogate, and what are the experiences of nurses in situations in which a surrogate has been used? An interview guide was developed and validated through a group discussion with 3 nurses. Interviews were conducted with 14 additional nurses who were employed from acute care, sub-acute care, home health care, and private practice settings. Each participant was asked to describe how they assess older patients to determine decision-making capacity, what factors might indicate the need for a surrogate, and the experiences they have had when surrogates were used. Demographic data were collected from all participants. Trustiworthiness of the data was established through tests of credibility, transferability, dependability and confirmability. Triangulation was achieved and a chain of evidence was maintained through interview transcripts, field notes, and journaling. Data analysis procedures included open coding and emergent category designation. Results demonstrated that nurses were comfortable with their skills in assessing decision-making capacity and were familiar with the Surrogate Act in their state. The investigator found that nurses comfortably assess decision-making capacity regularly. Nurses did not, in general, express strong doubts about their assessment skills for determining decision-making capacity, nor did they lament lacking time for such assessments. Results of this study demonstrate that bedside assessment of decision-making capacity by nurses is not only realistic, but necessary for accurate and on-going determinations of the older patient’s ability to make important health care decisions.

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