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Recognition and assessment of resident’ deterioration in the nursing home setting : A critical ethnography
Laging, Bridget Kenny, Amanda Bauer, Michael Nay, Rhonda
Laging, Bridget
Kenny, Amanda
Bauer, Michael
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.
Keywords
decision-making, geriatric nursing, hospital transfer, hospitalisation, nurse assistant, nurse roles, nurse staff, nurses, nursing assessment, nursing homes, nursing roles, nursing workforce, scope of practice
Date
2018
Type
Journal article
Journal
Journal of Clinical Nursing
Book
Volume
27
Issue
7-8
Page Range
1452-1463
Article Number
ACU Department
School of Nursing, Midwifery and Paramedicine
Faculty of Health Sciences
Faculty of Health Sciences
Relation URI
Source URL
Event URL
Open Access Status
License
All rights reserved
File Access
Controlled