International Perspectives of Care for Older Adults in the ED: Voices of Emergency Department Nurses

Thursday, 2 August 2012: 3:55 PM

Mary Cadogan, DrPH, RN, GNP
School of Nursing, University of California, Los Angeles, CA
Robyn Gallagher, RN, BA, MN, PhD
Faculty of Nursing, Midwifery and Health, University of Technology, Sydney, Sydney, Australia
Linda Phillips, PhD
School of Nursing, University of California Los Angeles (UCLA), Los Angeles, CA
Carolyn Ziminski, RN, BSN
School of Nursing, University of California, Los Angeles, Los Angeles, CA

Purpose: Although Emergency Departments (ED) are frequent sites of care for older adults and often are associated with post-ED adverse events, little is known from the perspectives of ED nurses about their experience providing care for rapidly increasing numbers of older adults.   As part of two larger studies exploring issues in the care of older adults in the ED, the purpose of this study was to compare the perceptions of ED nurses from two large urban hospitals (in Los Angeles, USA and Sydney, Australia).  Nurses who spoke English and worked in the ED for at least 6 months were eligible to participate. The final sample of 46 nurses (19 USA and 27 Australia) was 28% male, with ED experience ranging from 1-33 years.

 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.