Older patients comprise a large portion of patients in the acute care setting. Registered Nurses (RNs) are the main care providers in the hospital setting. RNs caring for older hospitalized patients are affected by many factors including workload pressures, issues related to the acute care environment and attitudes toward older patients. However, a literature review identified a limited number of studies exploring the RNs experience of caring for older patients in the acute care setting. This study explored the RNs experience of caring for older patients (age 65 and older) on an orthopedic unit in an acute care hospital. Saturation was reached with a purposive sample of nine RNs working on the orthopedic unit, including eight females and 1 male. Participants were interviewed using broad open-ended questions, followed by questions more specific to emerging themes. All interviews were audio-taped and transcribed verbatim. Data were analyzed using Glasers (1992) grounded theory approach. Participants described the basic social problem as dealing with the complexity of older patients. The basic social process identified was the concept of looking beyond. Looking beyond was described as looking at the big picture to find what lies outside the scope of the ordinary. Three sub-processes of looking beyond were identified as connecting, searching, and knowing. Connecting was described as getting to know patients as a person by taking time, respecting and understanding the individual. Searching was described as digging deeper, searching for the unknown by looking for clues and mining everywhere for information. Knowing was described as intuitively knowing what is going to happen and what the older patient needs by pulling it all together and knowing what to expect. These dynamic sub-processes provided the RN with the relationship and information required to look beyond to manage the older patients complexity. The results of this study have implications for nursing practice, education and research. These findings may provide RNs with a process to manage the complex care of a large portion of our population.

Older patients comprise a large portion of patients in the acute care setting. Registered Nurses (RNs) are the main care providers in the hospital setting. RNs caring for older hospitalized patients are affected by many factors including workload pressures, issues related to the acute care environment and attitudes toward older patients. However, a literature review identified a limited number of studies exploring the RNs experience of caring for older patients in the acute care setting. This study explored the RNs experience of caring for older patients (age 65 and older) on an orthopedic unit in an acute care hospital. Saturation was reached with a purposive sample of nine RNs working on the orthopedic unit, including eight females and 1 male. Participants were interviewed using broad open-ended questions, followed by questions more specific to emerging themes. All interviews were audio-taped and transcribed verbatim. Data were analyzed using Glasers (1992) grounded theory approach. Participants described the basic social problem as dealing with the complexity of older patients. The basic social process identified was the concept of looking beyond. Looking beyond was described as looking at the big picture to find what lies outside the scope of the ordinary. Three sub-processes of looking beyond were identified as connecting, searching, and knowing. Connecting was described as getting to know patients as a person by taking time, respecting and understanding the individual. Searching was described as digging deeper, searching for the unknown by looking for clues and mining everywhere for information. Knowing was described as intuitively knowing what is going to happen and what the older patient needs by pulling it all together and knowing what to expect. These dynamic sub-processes provided the RN with the relationship and information required to look beyond to manage the older patients complexity. The results of this study have implications for nursing practice, education and research. These findings may provide RNs with a process to manage the complex care of a large portion of our population.