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Older people's experiences in acute care settings: systematic review and synthesis of qualitative studies

Older people's experiences in acute care settings: systematic review and synthesis of qualitative studies
Older people's experiences in acute care settings: systematic review and synthesis of qualitative studies

Background: There is no recent synthesis of primary research studies into older people's experiences of hospital care. Objective: To synthesise qualitative research findings into older people's experiences of acute health care. Design: Systematic procedures for study selection and data extraction and analysis. Comparative thematic approach with meta-ethnographic features for synthesis. Data sources: Worldwide grey and published literature written in English between January 1999 and December 2018 identified from databases: CINAHL, Medline, British Nursing Index, EMBASE Psychiatry, International Bibliography of the Social Sciences, PsychINFO, and AgeInfo. Review methods: Systematic review and synthesis of 61 qualitative studies and two systematic reviews describing older patients’ experiences of care in acute hospital settings. Results: The physical and social environment of the hospital positioned many older patients as insignificant and powerless to influence the care they received. Patients subjugated their needs to those of staff and other patients, holding back information and requests for help. Patient knowledge of the time-based schedules for care, and experiences of waiting for care and of staff limiting their time with them served to reinforce patients’ feelings of insignificance and powerlessness, reflecting the perceived primacy of bureaucratic organisation of care over individual needs and preferences. Highly negative experiences would result if these aspects of context were not mediated by individualised relational work by staff, nursing staff in particular. Some groups of patients were at particular risk of negative experiences: people with dementia and/or delirium; people with difficulty communicating, hearing or understanding; people from ethnic minority groups, especially where there was a language difference; people with low functional/physical ability; people with low literacy; and people without regular visitors and/or family support. Three key features of care consistently mediated negative feelings and were linked to more positive experiences were: “maintaining identity: see who I am”, “building relationships: connect with me”, and “partnering in care: involve me”. Conclusion: Older people's care experiences in hospital may be negative in the absence of relational work by nurses to maintain people's identity, establish caring connections and ensure that individual patient needs, preferences and values are honoured in the care that is delivered. Relational care by nurses can mediate powerful institutional drivers that may otherwise result in negative experiences and poor care. Organisational and service-wide commitment are needed to create the culture and context in which relational care can flourish. Tweetable abstract: Synthesis of qualitative research on older ppl's hospital experiences: hospital's physical and social environment positions older ppl as insignificant and powerless. Highly negative experiences result if impact of context not mediated by individualised relational work by nurses.

Aged, Aged, 80 and over, Hospitals, Human dignity, Professional-patient relations, Qualitative research
0020-7489
1-11
Bridges, Jackie
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Collins, Pippa
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Flatley, Mary
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Hope, Joanna
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Young, Alexandra
cd1a36bc-a2f9-4c84-9649-258f5ca7e031
Bridges, Jackie
57e80ebe-ee5f-4219-9bbc-43215e8363cd
Collins, Pippa
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Flatley, Mary
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Hope, Joanna
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Young, Alexandra
cd1a36bc-a2f9-4c84-9649-258f5ca7e031

Bridges, Jackie, Collins, Pippa, Flatley, Mary, Hope, Joanna and Young, Alexandra (2020) Older people's experiences in acute care settings: systematic review and synthesis of qualitative studies. International Journal of Nursing Studies, 102, 1-11, [103469]. (doi:10.1016/j.ijnurstu.2019.103469).

Record type: Review

Abstract

Background: There is no recent synthesis of primary research studies into older people's experiences of hospital care. Objective: To synthesise qualitative research findings into older people's experiences of acute health care. Design: Systematic procedures for study selection and data extraction and analysis. Comparative thematic approach with meta-ethnographic features for synthesis. Data sources: Worldwide grey and published literature written in English between January 1999 and December 2018 identified from databases: CINAHL, Medline, British Nursing Index, EMBASE Psychiatry, International Bibliography of the Social Sciences, PsychINFO, and AgeInfo. Review methods: Systematic review and synthesis of 61 qualitative studies and two systematic reviews describing older patients’ experiences of care in acute hospital settings. Results: The physical and social environment of the hospital positioned many older patients as insignificant and powerless to influence the care they received. Patients subjugated their needs to those of staff and other patients, holding back information and requests for help. Patient knowledge of the time-based schedules for care, and experiences of waiting for care and of staff limiting their time with them served to reinforce patients’ feelings of insignificance and powerlessness, reflecting the perceived primacy of bureaucratic organisation of care over individual needs and preferences. Highly negative experiences would result if these aspects of context were not mediated by individualised relational work by staff, nursing staff in particular. Some groups of patients were at particular risk of negative experiences: people with dementia and/or delirium; people with difficulty communicating, hearing or understanding; people from ethnic minority groups, especially where there was a language difference; people with low functional/physical ability; people with low literacy; and people without regular visitors and/or family support. Three key features of care consistently mediated negative feelings and were linked to more positive experiences were: “maintaining identity: see who I am”, “building relationships: connect with me”, and “partnering in care: involve me”. Conclusion: Older people's care experiences in hospital may be negative in the absence of relational work by nurses to maintain people's identity, establish caring connections and ensure that individual patient needs, preferences and values are honoured in the care that is delivered. Relational care by nurses can mediate powerful institutional drivers that may otherwise result in negative experiences and poor care. Organisational and service-wide commitment are needed to create the culture and context in which relational care can flourish. Tweetable abstract: Synthesis of qualitative research on older ppl's hospital experiences: hospital's physical and social environment positions older ppl as insignificant and powerless. Highly negative experiences result if impact of context not mediated by individualised relational work by nurses.

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Older people's experiences in acute care settings systematic review and synthesis of qualitative studies - Accepted Manuscript
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Accepted/In Press date: 28 October 2019
e-pub ahead of print date: 8 November 2019
Published date: February 2020
Keywords: Aged, Aged, 80 and over, Hospitals, Human dignity, Professional-patient relations, Qualitative research

Identifiers

Local EPrints ID: 435838
URI: http://eprints.soton.ac.uk/id/eprint/435838
ISSN: 0020-7489
PURE UUID: f0558b0d-8205-4c64-bab0-7872517c204c
ORCID for Jackie Bridges: ORCID iD orcid.org/0000-0001-6776-736X
ORCID for Joanna Hope: ORCID iD orcid.org/0000-0002-8939-7045

Catalogue record

Date deposited: 21 Nov 2019 17:30
Last modified: 26 Nov 2021 05:16

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Contributors

Author: Jackie Bridges ORCID iD
Author: Pippa Collins
Author: Mary Flatley
Author: Joanna Hope ORCID iD
Author: Alexandra Young

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