Perceptions, practices and educational needs of community nurses to manage frailty
Early intervention on frailty can help prevent or delay functional decline and onset of dependency. Community nurses encounter patients with frailty routinely and have opportunities to influence frailty trajectories for individuals and their carers. This study aimed to understand nurses' perceptions of frailty in a community setting and their needs for education on its assessment and management. Using an exploratory qualitative design we conducted focus groups in one Health Board in Scotland. Thematic content analysis of data was facilitated by NVivo© software. A total of 18 nurses described the meaning of frailty as vulnerability, loss and complex comorbidity and identified processes of caring for people with frailty. They identified existing educational needs necessary to support their current efforts to build capability through existing adversities. Our study indicates that current practice is largely reactive, influenced by professional judgement and intuition, with little systematic frailty-specific screening and assessment.
Frailty is a major public health challenge often associated with ageing (World Health Organization, 2015; Cesari et al, 2016), and it is linked with falls, disability, hospitalisation, care home admission and even death (Clegg et al, 2013). Definitions of frailty are based either on a specified, five-point phenotype (weight loss, exhaustion, low physical activity, slowness and weakness) (Fried et al, 2001) or as an accumulation of deficits on different domains, including the cognitive and physical domains (Rockwood et al, 2005). Both definitions have negative connotations, such as being vulnerable or incapable (Nicholson et al, 2016). The contested nature of frailty can be even more prominent in diverse socio-cultural contexts (Hanlon et al, 2018). The prevalence of frailty is around 11% in people over the age of 65 years living in the community (Collard et al, 2012). Nevertheless, frailty can be prevented by early intervention to reduce the rate of functional decline and dependency (Travers et al, 2019). Proactive interventions and integrated approaches in the community can prevent frailty and optimise intrinsic capacity (British Geriatrics Society, 2014).
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