Challenges and Barriers to Providing Care to Older Adult Patients in the Intensive Care Unit: A Qualitative Research

Abbas  Heydari; Mohammadhesam Sharifi; Ahmad  Bagheri Moghaddam

doi:10.3889/oamjms.2019.846

Authors

Abbas Heydari Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
Mohammadhesam Sharifi Department of Medical-Surgical Nursing, Faculty of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
Ahmad Bagheri Moghaddam Department of Anesthesiology, Internal Medicine and Critical Care, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

DOI:

https://doi.org/10.3889/oamjms.2019.846

Keywords:

Intensive care unit, Elderly patients, Nursing, Qualitative research, Qualitative content analysis, Palliative care, End of life care

Abstract

BACKGROUND: Enhancing the quality of care for elderly patients needs an understanding of the challenges and obstacles experienced by the intensive care unit (ICU) staff in providing care.

AIM: To explore the most challenging issues experienced by ICU staff, in particular, nurses, in the care of elderly patients in the general adult ICU.

DESIGN: A qualitative research design was employed. The Standards for Reporting Qualitative Research (SRQR) were followed.

METHODS: Based on theoretical sampling, we carried out 34 in-depth semi-structured interviews from two medical adult ICUs. Data analysis was carried out using qualitative conventional content analysis.

RESULTS: Data analysis led to the identification of three interrelated categories and 12 subcategories. Three main categories were factors related to nursesâ€™ attitude in elderly care, factors related to the system of care, and factors related to the models of patient care delivery. These categories came under the main theme of "Inappropriate and unfair system for elderly care".

CONCLUSION: The findings of this study increase scholarly understanding of challenges and barriers to providing care to elderly patients in the general adult ICU. We found that the provision of care to elderly patients is inappropriate and unfair. Various obstacles must be overcome to improve the care of these patients. For example, negative attitudes toward elder care, inappropriate environments, lack of resources, lack of knowledge and skills, a specialized model of care delivery, respect for humanity, care without considering patient age, and separating professional conflicts from patient care. These findings may be used by ICUâ€™s caregivers and managers to improve the quality of care.

IMPLICATIONS FOR PRACTICE: Various obstacles were documented that need to be overcome by hospital administrators, nursing managers, clinical nurses, nursing educators, nursing researchers to improve the care of elderly patients admitted to ICU.