References
Who Bears Responsibility for the Post-Acute Older Adult: Patient, Family or State?
Abstract
Aim:
This study explores the perceptions of hospital discharge coordinators on the issues raised for the post-acute older adult and their family, using the lens of assisted decision-making and advance directives.
Background:
New legislation has been developed in Ireland to support assisted decision-making and advance directives that is largely consistent with other countries around the world. The Assisted Decision-Making Act of 2015 was fully commeced in April 2023, following lengthy debate. However, there is a lot of professional uncertainty regarding how to support and integrate Advance Healthcare Directives and assisted decision-making into the care of adults and into the role of nurses working in the community.
Methods:
Utilising a qualitative approach, this study conducted a series of five focus groups, with 23 participants, across the South-East of Ireland. Thematic analysis was used to interpret results. The 32-item consolidated criteria for reporting qualitative research checklist was utilised.
Findings:
The central finding in this study concerned the locus of control, as well as findings on burden of care and the role of the nurse. A stark incongruence of beliefs among patient, family and State was identified.
Conclusion:
Nurses must learn to circumnavigate the complex terrain involved in supporting the older adult’s advance decision-making and advance healthcare directives.
The COVID-19 pandemic awakened international consciousness regarding the vulnerability of the world’s elderly and, in particular, the post-acute-care elderly (Gray-Miceli et al, 2020). Internationally, legislative frameworks have been developed or reformed in recent years, to support advance care planning and assisted decision-making in healthcare (Ní Shé et al, 2018; Dowling et al, 2020). However, while different jurisdictions employ a variety of approaches, universal uncertainty remains about how to support healthcare decision-making in older adults across the geographic divides (Donnelly, 2019). International research acknowledges increased care need of the older adult following a hospital stay (Sacks et al, 2015; Lichtman et al, 2020; Vilches-Moraga, 2020; Lee et al, 2022). However, it is largely unknown who exactly provides this care to the older patient (Beard and Bloom, 2015; Kottow, 2018). Claims of ‘informal family carers’ and ‘community supports’ are evident across the literature but are largely unquantified internationally (Beard and Bloom 2015; Kottow, 2018).
Register now to continue reading
Thank you for visiting Community Nursing and reading some of our peer-reviewed resources for district and community nurses. To read more, please register today. You’ll enjoy the following great benefits:
What's included
-
Limited access to clinical or professional articles
-
New content and clinical newsletter updates each month