Reflections on care: older people speak about experiences of nursing care in acute medical and surgical wards

Abstract

This phenomenological study describes what it is like for people over 74 years to experience nursing care in acute medical and surgical wards, and relates their insights to implications for nursing practice. The six people who took part responded to newspaper stories inviting older people who had been in hospital recently to speak with a nurse researcher about the times they spent with nurses. They included eight episodes of hospitalisation in seven acute care public hospital wards. All chose to be interviewed in their own homes. The approach followed van Manen's (1990) method for researching lived experience. Their stories are contained in this thesis as individual chapters. The analysis moved from description largely in the respondents' own words, to the researcher's portrayal of the "free act of seeing" resulting in explication of salient features or structures of each story, and then to hermeneutic reflection using the four existentials of lived body, lived space, lived time and lived relation to others. Aggregation of the concerns revealed in each story illuminates the commonalities and differences of each and uncovers aspects of lived care for these people. Notions of care may be experienced negatively, as when care is absent or deficient in meeting patient need and expectation, or positively as when care is fully realised in the nurse-patient encounter. Nursing which includes negotiating the systems, mediating interpersonal issues, and practical help was excellent care for these patients. Value was given to the ability to quickly evaluate a patient's life ways of being and acknowledge these as of equal importance to the expected health outcomes from the particular medical diagnosis and intervention. The description of older people's experience of nursing care is useful for the potential to increase understanding of the needs and expectations of older people in acute wards. Through the phenomenological practice of reflecting and re-writing new perspectives on nursing are developed. These are expressed through myth and metaphor as one means of enhancing the caring work of nursing toward older people. The study offers some implications for nursing education, practice and the organisation of health (illness) care.