Understanding assessment on a hospital ward for older people: A qualitative study.

To explore assessment on a hospital ward for older people from the perspectives of patients and healthcare professionals. A qualitative study drawing on grounded theory was undertaken between February 2015 - January 2016. Interviews with 15 patients and 22 healthcare professionals, a focus group with six healthcare professionals, 45 hr of observation and review of 18 sets of patient notes. Analysis was conducted using initial and focused coding, continuously comparing data, emerging codes and themes. The core category was navigating, constructed through three themes: containing complexity, networking, and situating the process. Navigating assessment was a complex, flexible, context dependent, and social process where healthcare professionals used a combination of formal, informal, visible, and invisible ways of working. Registered nurses were at the centre of networking and focused on gathering and sharing information in the multi-disciplinary team, whilst patients had a passive role despite a variety of preferences about their involvement. Navigating the assessment of older people is contextually situated, includes networking and a professional focus on containing complexity. This process may be enhanced by: (a) making informal assessment visible to others; (b) developing the nurses' role beyond chasing information towards coordinating care; and (c) asking patients and acting on how they would like to be involved in decision-making. Acknowledging that navigating assessment is a social, flexible and complex process, including different ways of working to meet patient needs, may enhance the usability of current assessment guidelines and their development. 目的: 从患者和医疗保健专业人员的角度探讨老年人病房的评估。 设计: 从2015年2月至2016年1月期间,根据扎根理论进行了定性研究。 方法: 采访15名患者和22名医护人员,由6名医护人员组成一个焦点小组,对18组患者记录进行45小时的观察和审阅。使用初始和重点编码进行分析,不断比较数据、新兴编码和主题。 研究结果: 核心范畴是了解,由三个主题构成:包含复杂性,网络化,过程定位。了解评估是一个复杂灵活并依赖于环境和社会的过程,医疗保健专业人员使用正式、非正式、可见和不可见的工作方式。 网络化的中心是多学科团队中着重收集和共享信息的注册护士,尽管患者在自身参与时有各种偏好,但都扮演着被动的角色。 结论: 了解老年人的评估是根据具体情况进行的,包括网络化和从专业角度聚焦包含复杂性。这一过程可通过以下方式加强:(a)提供非正式评估,让他人看到;(b)发挥护士的作用,而不仅仅是寻求信息以协调护理;(c)询问患者意向,采取行动让患者参与决策。 影响: 承认了解评估是一个社交性的灵活复杂过程,包含满足患者需求的不同工作方式,可以提高当前评估指南及其发展的可用性。.

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