Care of the older person in emergency: the nursing COPE study

This study is titled ‘Nursing Care of the Older Person in Emergency’ (C.O.P.E). This study sought to answer the question: “How does nurses’ knowledge of ageing and attitudes towards older persons influence clinical practice and therapeutic interactions in Emergency Department settings?” Older patients constitute an increasing number of presentations to Australian emergency departments (ED); and the nurses employed in the EDs specialise in trauma, and may have no or little experience with the specialised care required for the older person’s chronic and complex care needs. The ED’s fast-paced environment is inconsistent with older people’s chronic and complex needs, and can impact on both the ED nurse and older patient. This study explored nurses’ knowledge and understanding of the ageing process and their attitudes towards the older person; and the impact on their clinical practices and therapeutic interactions in emergency department settings. A person-centred care framework was used as the conceptual framework for the study. A mixed methods approach was used in the study and included two phases. Phase one incorporated a survey that was distributed to all of the members (n=973) of the College of Emergency Nursing Australasia (CENA). Phase two of the study involved semi-structured interviews with fourteen emergency nurses at two regional hospitals in Australia. The findings of the survey suggested that ED nurses had a basic knowledge of the ageing process and related care issues. The findings of the qualitative interview with nurses revealed many issues that mitigate the provision of person centred care in the ED setting. The attitude towards the older person in both phases were variable with the interview data revealing ageist attitudes that were not revealed in the survey. In conclusion, ED nurses’ negative attitudes and inadequate knowledge about ageing can lead to poor clinical practice and an increase in adverse events for older people. This study indicates that ED nurses need to be equipped with appropriate attitudes and knowledge that will support older patients’ health care decisions and needs. If the ED nurse can recognise the unique needs of the older person, then discrimination and marginalisation of the older person can be prevented, and person centred care can be achieved in the ED setting.