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.

Le concept d’Hôpital Promoteur de Santé (HPS) a pris beaucoup d’importance depuis son élaboration vers la fin des années quatre-vingt. Dans le contexte de la dernière réforme, le réseau montréalais des HPS et CSSS a été créé. Le Centre Universitaire de Santé McGill (CUSM) fait partie de ce réseau depuis 2007. Cette étude vise la création d’un milieu hospitalier promoteur de la santé pour les patients et s’adresse à l’expérience d’un repas pour les personnes âgées nécessitant une diète purée. Une étude de cas qualitative a été utilisée pour explorer la perception de patients vis-à-vis les aspects relatifs à leur cabaret, l’assistance qu’ils recevaient et le contexte social de leur repas. Les impressions des professionnels de la santé quant à l’expérience des patients ont aussi été obtenues. Les résultats indiquent que l’identification difficile des aliments en purée, la saveur, l’apparence et la variété sont tous des éléments qui affectent négativement leur expérience repas. Des sentiments d’impuissance ont aussi été rapportés par les patients et les professionnels de la santé. Le contexte social du repas a été souligné comme étant un aspect à cibler pour améliorer l’expérience des patients. Un programme utilisant des purées formées pourrait contrecarrer les effets négatifs de la prescription d’une diète purée. Des changements dans les pratiques infirmières, à savoir la création d’une ambiance sociale agréable au moment des repas, semble être une option peu couteuse qui pourrait améliorer l’expérience repas des patients et diminuer les sentiments d’impuissance relevés par les professionnels de la santé à l’égard de cet aspect de soin. / The Health Promoting Hospital (HPH) concept has gained much momentum since its development in Europe in the late nineteen eighties. The Montreal network of HPH was created in 2005, within the context of the last reform. The McGill University Health Center (MUHC) is a part of this network since 2007. This study focuses on the creation of a health promoting hospital setting for patients and addresses the mealtime experience of older hospitalized patients requiring a puree diet. A qualitative case study design was used to explore patients’ perceptions of aspects of their puree meal tray, assistance provided by staff and the social context in which the meal was taken. Health professionals’ view of the patients’ experience were also obtained. Results indicate that the difficult identification of food items, flavour, appearance and variety were all important factors negatively affecting the mealtime experience. Feelings of loss of control were also reported by patients and staff. The social context in which the meal was taken was highlighted as an area which could be targeted to improve mealtimes. A program using formed puree food items could help lessen the negative impact of the prescription of a puree diet. Changes in nursing practices regarding the creation of a pleasant social atmosphere were identified as an inexpensive option to improve the mealtime experience for patients and decrease feelings of lack of control for staff in this aspect of care.

Le concept d’Hôpital Promoteur de Santé (HPS) a pris beaucoup d’importance depuis son élaboration vers la fin des années quatre-vingt. Dans le contexte de la dernière réforme, le réseau montréalais des HPS et CSSS a été créé. Le Centre Universitaire de Santé McGill (CUSM) fait partie de ce réseau depuis 2007. Cette étude vise la création d’un milieu hospitalier promoteur de la santé pour les patients et s’adresse à l’expérience d’un repas pour les personnes âgées nécessitant une diète purée. Une étude de cas qualitative a été utilisée pour explorer la perception de patients vis-à-vis les aspects relatifs à leur cabaret, l’assistance qu’ils recevaient et le contexte social de leur repas. Les impressions des professionnels de la santé quant à l’expérience des patients ont aussi été obtenues. Les résultats indiquent que l’identification difficile des aliments en purée, la saveur, l’apparence et la variété sont tous des éléments qui affectent négativement leur expérience repas. Des sentiments d’impuissance ont aussi été rapportés par les patients et les professionnels de la santé. Le contexte social du repas a été souligné comme étant un aspect à cibler pour améliorer l’expérience des patients. Un programme utilisant des purées formées pourrait contrecarrer les effets négatifs de la prescription d’une diète purée. Des changements dans les pratiques infirmières, à savoir la création d’une ambiance sociale agréable au moment des repas, semble être une option peu couteuse qui pourrait améliorer l’expérience repas des patients et diminuer les sentiments d’impuissance relevés par les professionnels de la santé à l’égard de cet aspect de soin. / The Health Promoting Hospital (HPH) concept has gained much momentum since its development in Europe in the late nineteen eighties. The Montreal network of HPH was created in 2005, within the context of the last reform. The McGill University Health Center (MUHC) is a part of this network since 2007. This study focuses on the creation of a health promoting hospital setting for patients and addresses the mealtime experience of older hospitalized patients requiring a puree diet. A qualitative case study design was used to explore patients’ perceptions of aspects of their puree meal tray, assistance provided by staff and the social context in which the meal was taken. Health professionals’ view of the patients’ experience were also obtained. Results indicate that the difficult identification of food items, flavour, appearance and variety were all important factors negatively affecting the mealtime experience. Feelings of loss of control were also reported by patients and staff. The social context in which the meal was taken was highlighted as an area which could be targeted to improve mealtimes. A program using formed puree food items could help lessen the negative impact of the prescription of a puree diet. Changes in nursing practices regarding the creation of a pleasant social atmosphere were identified as an inexpensive option to improve the mealtime experience for patients and decrease feelings of lack of control for staff in this aspect of care.