The care of older adults in hospital: if it's common sense why isn't it common practice?
OBJECTIVE
To present three converging myths that underlie the perception that nursing care for older persons in hospital is simple in comparison with its actual complexity.


BACKGROUND
Literature provides strong evidence indicating that the myths we discuss inherently arise from ageism, the social value of older patients and the economic burden of being an older patient in hospital. These powerful social discourses promote harm to older patients. Harm emerges from both the omission of gerontological nursing knowledge and skill and the commission of acts that unintentionally harm. A corresponding ethical challenge results for acute care nurses.


METHODS
A discursive paper.


METHODS
We illuminate gerontological issues by discussing three myths. In myth one, we detail four clusters of distinguishing characteristics in older hospitalised people. In the second myth, we challenge the idea that the role of the acute care hospital is to attend only to acute medical concerns. Finally, in the third myth, we address the issue of incorporating functional assessment into the acute care nursing assessment. We argue that functional assessment is poorly integrated and becomes acceptable only as long as the medical regimen is managed appropriately.


CONCLUSIONS
Safe quality care in hospital for older adults requires a hybrid practice that integrates acute care specialty knowledge with gerontological nursing knowledge and skill. Clinical reasoning that integrates this type of nursing knowledge can prevent harm.


CONCLUSIONS
Integrating key elements of acute care nursing specialty knowledge with gerontological nursing principles aids to prevent the omission of care that is known to be harmful to older people. Conversely, the commission of gerontologically sensitive acute care can enhance safety and promote quality care in hospital.
Faculty of Nursing Level 3, Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, Canada.
Belinda
B
Parke
Kathleen F
KF
Hunter
D000368:Aged; D005851:Geriatric Nursing; D006299:Health Services for the Aged; D006760:Hospitalization; D006801:Humans; D058996:Quality Improvement
clinical reasoning in gerontological nursing; hospital; older adults