Nursing attitudes to the care of elderly patients at risk of continuing hospital care

Abstract

This study assesses changes in nurses' attitudes to the process of decision-making regarding the care of elderly patients identified as being at risk of continuing (long-term) hospital care. It was undertaken during the course of an evaluation of an intervention programme which involved a new approach to decision-making concerning the long-term care of dependent elderly patients. Complementary components of the intervention programme were: (a) an early discharge planning service; and (b) an extended home care programme. The programme involved close liaison of specially trained community health nurses with staff members of the general medical wards of a large general hospital. At the onset of the evaluation, it was perceived by management that the staff of the general medical wards favoured continuing hospital care for very dependent elderly patients rather than community care. It was hypothesized that the intervention programme would result in a change in ward staffs' attitudes concerning the feasibility of home-based care and how decisions about care should be made. To test this, attitude changes of community health nurses and ward nurses were assessed over the period of implementation of the programme. Following the introduction of the programme, the study found that some of the ward nurses' attitudes became closer to those of community health nurses. There was a shift in ward nurses' attitudes away from a professional approach to decisions about the care and placement of very dependent elderly patients to a 'patient choice' approach. Nurses felt more strongly that they had an important role in patient care. Implications of the research are considered in relation to the process of discharge planning.