AUTOETHNOGRAPHY

Autoethnography

Autoethnography

Introduction

Optimizing care for hospitalized older adults is an important goal, given that the majority of patients in hospitals are older adults and they are the most likely to experience complications. Data from the United States indicates that individuals 65 years of age and over comprise 60% of hospital admissions, represent 48% of hospital days, and compared with other age groups have longer lengths of stay. Similar to the United States, older Canadians account for a third of all acute-care hospitalizations and about half of all hospital days, with an average length of stay of nearly 11 days compared with 5 days for patients younger than 65 years (Williams & Crespo, 2008). This trend is also evident in the province of Manitoba, the setting of the present study, where individuals 65 years of age and over have been shown to incur 60% of all hospital days and 59% of all inpatient costs in the province. Once admitted to the hospital, older adults are at increased risk for experiencing adverse events (e.g., acute confusion and nosocomial infections), increased length of stay, readmission, and functional decline. Development of elder-friendly care environments is hindered by lack of formal education regarding the specialized nursing needs of older patients.

This lack of gerontological nursing content has been noted in both Canada and the United States. Specifically, based on a review of gerontological nursing content in Canadian baccalaureate nursing programs, Baumbusch and it is found that only 8% of clinical hours had a focus on nursing older adults and only 5.5% of students chose geriatrics for their final clinical placement prior to graduation (Gobble, 2009). As the number of older adults increases, the need for well-educated, skilled gerontological nurses will continue to increase.

In addition to a lack of specialized geriatric nursing care, shortcomings within the acute care hospital environment in Canada (e.g., staffing issues, physical environment) also have an impact on creating an elderfriendly care environment. Most often, nurses within acute care hospitals focus solely on managing the care required for acute illnesses. This can be a disadvantage to older adults, who are often hospitalized because of an acute episode, but are facing chronic health problems.

Strategies are needed to narrow the gap between what older adults need and what the hospital environment offers, including systems and processes to support the needs of professionals working in the hospital environment. These strategies will need to be creative and flexible to deal with fiscal restraint, competing priorities, and pressure from the public to provide elder-friendly hospital care. One important aspect of the work environment is the type of hospital in which care is provided. The question of whether hospital type, in this case geriatric-chronic, community, and tertiary relate to perceptions of the geriatric nurse practice environment has not yet been examined. Examining perception of the geriatric care environment across different care settings is a first step in determining where change or education is most needed in order to ensure the best quality of care for older ...