Constructing definitions of safety risks while nurses care for hospitalised older people: Secondary analysis of qualitative data

Abstract

Aim: The aim of this secondary qualitative descriptive analysis was to examine how nurses construct a definition of older peoples' safety risks and provide care while working within organisational contexts that are focused on diminishing patient risks.

Background: Numbers of older patients are increasing in acute hospital contexts-contexts that place their focus on patient safety. Nurses need to manage tensions between older peoples' risks, evidence-informed practice decisions, limited resources and organisational emphases on patient falls. To date, their practice dilemmas have not been well examined.

Design: A secondary qualitative descriptive analysis was conducted using data that were collected between June 2010 and May 2011 to examine nursing practice with hospitalised older people.

Methods: All field notes and transcribed data were reviewed to generate themes representing 18 Registered Nurses' perceptions about safe care for hospitalised older people. The first author generated categories that described how nurses construct definitions of safety risks for older people. All authors engaged in an iterative analytic process that resulted in themes capturing nurses' efforts to provide care in limited resource environments while considering older peoples' safety risks.

Results: Nurses constructed definitions of patient safety risks in the context of institutional directives. Nurses provided care using available resources as efficiently as possible and accessing co-worker support. They also minimised the importance of older people's functional abilities by setting priorities for medically delegated tasks and immobilising their patients to reduce their risks.

Conclusions: Nurses' definitions of patient risk, which were shaped by impoverished institutional resources and nurses' lack of valuing of functional abilities, contributed to suboptimal care for older adults. Nurses' definitions of risk as physical injury reduced their attention to patients' functional abilities, which nurses reported suffered declines as a result.

Implications for practice: Leaders need to examine how organisational emphases on particular areas of patient safety and resource constraints contribute to suboptimal care of older people. Nurses understanding of patient risk must incorporate older patients' functional abilities.

Keywords: nursing care; older people; patient risk; qualitative research; secondary analysis.