Management of care for hospitalized older persons - comfort as an essential outcome: a qualitative study

Abstract

Background

The global aging population highlights the need for accurate care management, tailored to their specific needs. This study investigated the production of comfort as a therapeutic outcome of nursing care management for hospitalized older persons.

Methods

This exploratory descriptive research was conducted in 9 medical wards and 4 surgical wards of a university hospital in the state of Rio de Janeiro, Brazil, via a qualitative approach. Between May and June, 2022, the researchs collected data from 19 nurses in management positions. Semistructured interviews were conducted, and the researchers investigated the data thus collected via thematic-categorical content analysis on the basis of the approach developed by Bardin. The theoretical framework was based on Kolcaba’s Comfort Theory.

Results

Inadequate staffing was the main challenge among the forces (barriers) that were observed to obstruct the care management of hospitalized older persons, what lead to task prioritization that favored techinical over comfort-focued care. Additionally, the overload and stress faced by nurses created discomfort for the team, which was reflected in the care that they provided. The results also revealed that a lack of knowledge represented a significant challenge because professional insecurity led nurses to choose restrictive interventions; however, this approach ultimately sacrified comfort. Alongside with leadership, experience emerged as a primary facilitating force. The main risks faced by hospitalized older persons that were identified by nurses included falls, pressure injuries, delirium, pneumonia, and bronchoaspiration. The main nursing interventions used to ensure comfort and safety of hospitalized older persons pertained to the environment as well as to the need to encourage the presence of family members. However, intervening variables, beyond the professional’s control, such as inapproprieted hospital infrastructure and the unavailability of family members, were not considered. As a result, the interventions proved to be ineffective since they did not address these factors that impacted patient’s levels of comfort.

Conclusions

Analysis of the findings of this research revealed that although care management focused on promoting comfort, safety and autonomy among patients, nursing practices prioritized patient safety while sacrificing comfort and autonomy.

Trial registration

This work was approved by the Ethics Committee - no. 57513722.0.0000.5282.