The nurse's role in promoting the involvement of older patients and informal carers in the assessment of their individual continuing health and social care needs
This thesis looks at the concept of involvement as it applies to older patients and their informal carers in the assessment of their own continuing care needs. In particular it is concerned with the nurse's role within the multidisciplinary team in facilitating the involvement of patients and informal carers in this process. The study was conducted in a district general hospital in London. Patient involvement in continuing care assessments was explored by following the care of 20 individual patients and their informal carers throughout their hospital stay, and after discharge in the community. Observations of key decision making activities in respect of these patients were contrasted with interviews with multidisciplinary staff who had been involved in their care, to provide insights into assessment practice. Interviews with patients and informal carers gave an indicator of how involved they felt in their own assessments. In addition, interviews with 32 multidisciplinary staff provided more general data on professionals' perceptions of their own roles with regard to involving patients in assessments. Analysis of the data revealed nurses were not being seen to be contributing to the assessment of patients' continuing care needs. Nurses' marginal position in continuing care assessments meant that it was particularly difficult for them to facilitate the involvement of patients and informal carers. What makes these findings all the more remarkable is the fact that nurses' continual presence on the ward was almost universally seen by the multidisciplinary team as offering them unrivalled opportunities to build a rapport with patients and thereby develop better understandings of their needs. Furthermore findings suggest that continuing care assessments and patient and informal carer involvement in this process may be affected by strategic and practice issues, as well as factors relating to patients and informal carers themselves. One explanation for these findings may be offered by Nolan et al.'s (2002) 'senses' framework. The application of the framework to the data suggests that a lack of attention to, 'the fundamentals of care' may affect professional practice. In particular, applying the framework to this multidisciplinary context suggests that a lack of these 'fundamentals of care' in one discipline may also affect the practice of other members of the multidisciplinary team. Moreover, the findings indicate that the framework may be incomplete and that it may require modification by the addition of a 'sense of expertise'. It is intended that generalizations may be made at a theoretical level from this case study.