Research paperEmergency nurses’ knowledge and self-rated practice skills when caring for older patients in the Emergency Department
Introduction
The projected increase in the number of persons ≥65 years in most developed countries is well documented [1], [2], [3] and accordingly demand for emergency healthcare amongst older persons is increasing [4], [5]. As experienced internationally, Australia’s ageing population has prompted the need to focus attention on how healthcare is delivered to older emergency department (ED) users [6], [7]. Older persons ≥65 years in Australia are high users of ED services, representing approximately 20% of ED presentations, and are more likely to be admitted to hospital or have repeated ED visits [2], [4], [5], [8], [9], [10]. As separate specialities, emergency nursing and gerontic nursing are complex and require highly specialised skills and knowledge. Emergency department care of older patients combines these two complex specialties in order to provide optimum emergency care to a vulnerable population. Compared to younger patients, older ED users and particularly ‘frail’ older patients (80+ years [11]), can have chronic and complex conditions, multifaceted healthcare needs [2], [12], are more often acutely ill on presentation [4], [5], [13], have longer lengths of stay in the ED [6], [14] and have increased rates of adverse outcomes post ED discharge [2], [5]. Therefore, older ED users require increased nursing resources, in particular time and specialised knowledge [12]. However, essential care needs for older patients are not always adequately managed within the unique context of the ED environment [7], [15].
Models of care that are not compatible with the needs of older patients can have an impact on older ED users as well as staff that deliver care [16], [17]. The provision of safe and quality care for older patients in the ED is a key concern for nurses [18], [19], [20], and requires emergency nurses to be informed, educated and supported to deliver interventions and use models of care demonstrated to be beneficial for older patients [20], [21]. Clinical outcomes for older patients improve when they are cared for by nurses with specialised training [19], [22], and staff knowledge is seen as important for improvements in older patients’ care [21], [22], [23], [24], [25].
A literature review highlighted that emergency nurses’ knowledge and attitudes were major influences on the therapeutic interaction between nurses and older ED patients [17]. However, there is a dearth of literature on emergency nurses’ gerontic knowledge and their perceptions of care delivery for older patients.
Section snippets
Aims
As part of a wider study we explored how emergency nurses manage the care of older patients in the ED. In this paper we focus on the outcomes of a survey to assess emergency nurses’ gerontic knowledge and their self-rated assessment of practice in delivering care to older patients in the ED.
Design
A cross-sectional self-report study design was used.
Setting
The study was conducted at three EDs in public hospitals in Melbourne, Australia. In 2013/2014 annual presentations in these EDs were approximately 200,000 and older persons aged 65 years and over comprised 18% of these presentations.
Data collection tool
Data were collected using a paper based 59-item questionnaire consisting of three sections: a) knowledge of older adults and ageing; b) gerontic health related questions; and c) self-rated practice assessment.
Participant characteristics
There were 101 participants and their characteristics are summarised in Table 1. Most participants were RNs (73.0%, n = 74), and approximately one-third of RNs (32.4%, n = 24) were working in senior clinical, education or management roles. The low number of EN participants (2.9%, n = 3) was consistent with the small number of ENs that worked in the three EDs. All participants had over five year’s clinical experience. Approximately 41% (n = 41) had a postgraduate qualification and the highest education
Discussion
This study had three key findings: i) there was variation in knowledge about older persons; ii) there was variation in participants’ self-rating of practice in caring for older patients and; iii) there was a lack of congruency between self-rating of practice and knowledge of some aspects of older patients’ care. Previous investigations into gerontic knowledge of acute care nurses, including emergency nurses, found significant gaps [17], [22], [31], [32], [34]. However, the mean percentage of
Conclusion
Emergency nurses provide care to large numbers of ED users of all ages in a complex environment. The provision of evidence-based, age-appropriate care for older patients in the ED is an essential part of meeting the health needs of an ageing population. Ensuring that emergency nurses are able to appropriately meet the care needs of this growing and increasingly complex population in the ED is a key imperative in improving healthcare for older patients. High quality emergency care for older
Author contributions
HR, PB and JC conceived and designed the study. HR and JC conducted the literature review. HR collected the data. HR, CO and JC analysed the data. HR, AMH and JC prepared the manuscript. HR, PB, CO, AMH and JC critically revised and edited the manuscript draft prior to submission.
Funding
This study was funded by a grant from the Centre for Quality and Patient Safety Research (QPS), Deakin University.
Role of funding source
The funding body were not involved in any aspect of the research including design, analysis, and contents of this manuscript, or the decision regarding where to publish.
Provenance and conflicts of interest
No authors have any conflicts of interest or provenance issues to declare. Professor Julie Considine is a Deputy Editor of the Australasian Emergency Nursing Journal but had no role in the peer review and editorial or decision-making process. This paper was not commissioned.
Acknowledgements
The development of this research was supported by a competitive grant from the Centre for Quality and Patient Safety Research (QPS), Deakin University. Our sincerest thanks to the health service and staff of the emergency departments, and Research Assistants Catherine Au and Tania Cossich.
References (52)
- et al.
Older peoples’ experience of accessing emergency care
Australas Emerg Nurs J
(2010) - et al.
Nurses' perspectives of the impact of the older person on nursing resources in the emergency department and their profile: a mixed methods study
Int Emerg Nurs
(2015) - et al.
Older adults in the emergency department: a systematic review of patterns of use, adverse outcomes, and effectiveness of interventions
Ann Emerg Med
(2002) - et al.
Increasing the profile of the care of the older person in the ED: a contemporary nursing challenge
Int Emerg Nurs
(2008) - et al.
Assessing emergency nurses' geriatric knowledge and perceptions of their geriatric care
J Emerg Nurs
(2011) - et al.
The effect of a geriatric education program on emergency nurses
J Emerg Nurs
(2001) - et al.
The geriatric emergency nursing education (GENE) course: an evaluation
J Emerg Nurs
(2008) - et al.
Nurses' knowledge and attitudes towards older patients admitted to acute orthopaedic wards
Int J Orthop Trauma Nurs
(1998) The importance of nutrition in older adults
Eur Geriatric Med
(2011)- et al.
Prevalence and impact of pain among older adults in the United States: findings from the 2011 National Health and Aging Trends Study
PAIN®
(2013)
Pain in the emergency department: results of the pain and emergency medicine initiative (PEMI) multicenter study
J Pain
Discharge education for older people and family members in emergency department: a cross-sectional study
Int Emerg Nurs
Caring for the older person in the emergency department: the ASET program and the role of the ASET clinical nurse consultant in South Western Sydney, Australia
J Emerg Nurs
Demography is destiny: an agenda for geriatric emergency medicine in Australasia
Emerg Med Australas
3222.0–Population Projections, Australia, 2012 (base) to 2101
Demand for emergency department services in the elderly: an 11 year analysis of the Greater Sydney Area
Emerg Med Australas
Demand at the emergency department front door: 10-year trends in presentations
Med J Aust
Care of the older adult in the emergency department: nurses views of the pressing issues
Gerontologist
Toward patient-centered care: a systematic review of older adults' views of quality emergency care
Ann Emerg Med
Characteristics of frequent emergency department presenters to an Australian emergency medicine network
BMC Emerg Med
Emergency department utilisation among older people with acute and/or chronic conditions: a multi-centre retrospective study
Int Emerg Nurs
Emergency department care 2015-16: Australian hospital statistics
Operationalising frailty definitions in the emergency department: a mapping exercise
J Nutr Health Aging
The impact of very old patients in the ED
Br J Healthc Manag
Age-friendly nursing interventions in the management of older people in emergency departments
Nurs Health Sci
Hospital nurses' perception of the geriatric nurse practice environment
J Nurs Scholarsh
Cited by (9)
What are the needs of frail older patients in the emergency department? A qualitative study
2023, International Emergency NursingImpact of emergency department length of stay on anxiety and comfort in older people
2021, International Emergency NursingCitation Excerpt :Being in the ED may be particularly distressing and anxiety provoking for older people who are more likely to have a longer ED stay [9,10], and more frequently have diagnostic imaging and pathology testing [13] than younger patients. Older ED users are a vulnerable population with complex healthcare needs and they are highly reliant on ED clinicians to ensure their emergency care is safe [28]. Older ED users are more likely to have cognitive impairment, anxiety, depression [29], and are at risk of unrecognised functional decline, cognitive impairment and delirium [11,30].
Knowledge, attitudes, clinical practice and perceived barriers with nutrition support among physicians and nurses in the emergency department: A national cross-sectional survey
2021, International Emergency NursingCitation Excerpt :This study found that a higher level of knowledge in nutrition support was evident in physicians and nurses who: worked in a higher level of hospital (i.e. tertiary hospital versus community hospital), were older in age, had more years of employment, employed as physician rather than nurse, had a higher education background, higher professional title, and had received some form of training through a nutrition related program. These findings differ, in part, to other research undertaken in three public hospital EDs in Australia where nutrition knowledge level among emergency nurses did not differ based on years of work experience and education level [24]. This discrepancy could be due to the nature of education delivery in Chinese EDs where staff may obtain nutritional education through their time working clinically rather than via formal educational opportunities [16].
Consensus-based clinical research priorities for emergency nursing in Australia
2018, Australasian Emergency CareCitation Excerpt :These patient groups can be some of the most challenging to provide care for, and as such innovative, evidence informed ways to deliver safe, effective and holistic care is needed. Care of vulnerable populations is a defining feature of emergency nurses [49–51] and in Australia, emergency nurses are mandated to providing care for all Australians, irrespective of age, socio-economic status, or healthcare requirements [52]. Moreover, emergency nurses across Australia, and indeed elsewhere, have formal legal, professional and ethical obligation to care and advocate for vulnerable groups [53,54].
The Status of Geriatric In‑Hospital Nursing Care from the Perspective of Nurses Working in the Emergency Department of Hospitals in the Northwest of Iran in 2020
2023, Iranian Journal of Nursing and Midwifery ResearchREcognizing DElirium in geriatric Emergency Medicine: The REDEEM risk stratification score
2022, Academic Emergency Medicine