Recognition and assessment of resident’ deterioration in the nursing home setting : A critical ethnography

Journal article


Laging, Bridget, Kenny, Amanda, Bauer, Michael and Nay, Rhonda. (2018). Recognition and assessment of resident’ deterioration in the nursing home setting : A critical ethnography. Journal of Clinical Nursing. 27(7-8), pp. 1452-1463. https://doi.org/10.1111/jocn.14292
AuthorsLaging, Bridget, Kenny, Amanda, Bauer, Michael and Nay, Rhonda
Abstract

Aims and objectives
To explore the recognition and assessment of resident deterioration in the nursing home setting.

Background
There is a dearth of research exploring how nurses and personal‐care‐assistants manage a deteriorating nursing home resident.

Design
Critical ethnography.

Methods
Observation and semi‐structured interviews with 66 participants (general medical practitioners, nurses, personal‐care‐assistants, residents and family members) in two Australian nursing homes. The study has been reported in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines.

Results
The value of nursing assessment is poorly recognised in the nursing home setting. A lack of clarity regarding the importance of nursing assessments associated with resident care has contributed to a decreasing presence of registered nurses and an increasing reliance on personal‐care‐assistants who had inadequate skills and knowledge to recognise signs of deterioration. Registered nurses experienced limited organisational support for autonomous decision‐making and were often expected to undertake protocol‐driven decisions that contributed to potentially avoidable hospital transfers.

Conclusions
Nurses need to demonstrate the importance of assessment, in association with day‐to‐day resident care and demand standardised, regulated, educational preparation of an appropriate workforce who are competent in undertaking this role. Workforce structures that enhance familiarity between nursing home staff and residents could result in improved resident outcomes. The value of nursing assessment, in guiding decisions at the point of resident deterioration, warrants further consideration.

Keywordsdecision-making; geriatric nursing; hospital transfer; hospitalisation; nurse assistant; nurse roles; nurse staff; nurses; nursing assessment; nursing homes; nursing roles; nursing workforce; scope of practice
Year2018
JournalJournal of Clinical Nursing
Journal citation27 (7-8), pp. 1452-1463
PublisherWiley-Blackwell
ISSN0962-1067
Digital Object Identifier (DOI)https://doi.org/10.1111/jocn.14292
Scopus EID2-s2.0-85045943537
Research or scholarlyResearch
Page range1452-1463
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online24 Apr 2018
Publication process dates
Accepted23 Jan 2018
Deposited17 May 2021
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