Methods: A qualitative, descriptive methodology was used with focus groups (group size 4=8) to collect data at each site. Interviews were semi-structured focusing on nurses’ expectations and experiences of providing care to elders. Interviews were tape recorded, transcribed verbatim and data analyzed using constant comparative analysis to produce categories and major themes.
Results: The overarching theme common across sites was the mismatch between expectations and reality. Four subthemes (with some differences between groups) were identified. These included: 1) lack of congruence between perceived nursing role expectations and needs of elders; 2) care complexity related to the co-occurrence of advanced illness, multiple co-morbidities and geriatric conditions; 3) multiple competing agendas resulting from system limitations, needs of older patients and families, and expectations of other ED patients and staff; and 4) increased time demands associated with evaluation and management of non-urgent yet challenging problems.
Conclusion: ED nurses in two different care systems perceive many similar challenges and constraints in providing care for older adults. New models that support culture change and gerontological innovation within the ED are needed.