Background: There are many challenges in assessing older people in hospital and despite guidelines advocating Comprehensive Geriatric Assessment (CGA), there is a lack of clarity regarding how these patients are currently assessed in practice. Objective: To explore the assessment process on a ward for older people from the perspective of patients and health care professionals. Design: A constructivist Grounded Theory was used to understand assessment from different perspectives. Setting and subjects: Patients without cognitive impairment admitted to and professionals working on one ward for older people in an NHS University Hospital in England, UK. Methods: Data were collected between February 2015 and January 2016, including 37 interviews (15 patients, 22 professionals), a focus group (6 professionals), and 45 hours of fieldwork including observation and review of 18 sets of patient notes. Findings: The core category was ‘Navigating’, conveyed through three themes: ‘Containing complexity’, ‘Networking’, and ‘Situating the process’. Key findings were: (1) Navigating assessment is a complex, flexible, context dependent, and social process, (2) Health professionals use a combination of formal, informal, visible and invisible ways of working, (3) Registered nurses are at the centre of networking, spending most their time gathering and sharing information within the multi-disciplinary team, (4) Patients seemed to have a passive role, whilst expressing a variety of decision-making involvement preferences. Conclusions: Navigating the assessment of older people is contextually situated and involves less standardised, less visible and less formalised approaches to assessment than suggested in the guidelines. Awareness of all these aspects of navigating may result in their further utilisation and development. Nurses’ focussed on gathering and sharing information, but to move from “chasing” to “coordinating” patient care they need support from the multi-disciplinary team. Patients have limited participation within the navigating process, and their decision-making involvement preferences are not always elicited and facilitated.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:737749 |
| Date | January 2017 |
| Creators | Wiltjer, Hanneke |
| Publisher | University of Warwick |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://wrap.warwick.ac.uk/100403/ |
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