The experiences of home care nurses with acute health events leading to emergency department admission of frail community-dwelling older people: a qualitative study

Abstract

Background: Community-dwelling older people experience more acute health events due to their increasing frailty and to living independently as long as possible. Home care nurses provide daily care and support and play an essential part in recognising, anticipating, and managing acute health events in frail older people. However, home care nurses are generally qualified, and the quantity and complexity of acute health events require more specialised expertise and skills. Aim: To explore home care nurses’ challenges and experiences in recognising, anticipating, and managing acute health events leading to emergency department admission of frail community-dwelling older people to provide optimal care. Method: A generic qualitative descriptive study was conducted. Using a purposive sampling strategy, data were collected through semi-structured interviews with 12 home care nurses and thematically analysed. Results: Three main themes emerged: complexity of acute health events, the role of home care nurses, and prevention of acute health events. The complexity of acute health events was expressed in lack of expertise, an increase in care avoiders, and decrease in frail older people’s social network. Respondents struggled to assume an appropriate role in regard to collaboration, communication, and coordination during acute health events. To prevent and recognise acute health events early, respondents emphasised the importance of continuity of care and monitoring of frail older people. Conclusion and recommendations: To ensure optimal care an unambiguous definition of an acute health event, a clear delineation of the role of home care nurses, and more efficient collaboration and communication between healthcare professionals are needed. Consequently, more screening and measuring tools should be used in practice.