Nursing and the chronically ill patient in the acute‐care hospital

Abstract

The purpose of this exploratory interview study was to delineate the experience of nurses in a large acute-care/teaching hospital who provided nursing care to patients whose condition is characterized by: (a) chronicity, (b) severe functional debilitation, (c) whose care needs require maximum staff effort, and (d) whose potential for improvement was minimal. These patients are of significance for nurses because their predominant care needs are nursing, yet most nurses in the acute setting find the experience of providing care to these patients to be burdensome and discouraging. However, based on the data to be reported on here, there were nurses in the study who found the experience to be both challenging and rewarding. Discussion is on the experience of nurses who found a challenge and reward in the experience and focuses on (a) what they found in the nursing care of these patients to be a challenge and rewarding and why, (b) how their expectations for the patient and their perspective on the patient's progress enhanced provision of care to these patients, and (c) their impact on the ward vis-à-vis their peers. Implications for nursing practice are discussed.

Nursing staff's perceptions of work in acute and long‐term care hospitals

“…A number of interview and survey studies have found that both nursing students (Hooper 1981a, 1981b, Snape 1986) and nursing staff (Campbell 1971, Gillis 1973, Davis 1984 find work with chronic elderly patients discouraging, burdensome and unchallenging. Two sets of factors lie behind these complaints: on the one hand, the actual working conditions are obviously difficult, and there are also problems related to the work organization and work content; on the other hand, the complaints have a background in certain value attitudes.…”

“…Although the cure model and the corresponding organizational structures to a great extent shape the nursing stafTs values and concrete work practices, certain individuals and care units have managed to break loose and create their own standards and guidelines which better correspond to the needs of long-term care. Davis (1984) carried out a study in an acute care hospital which also had wards for chronically ill patients. The nurses who complained that the care of low-priority patients was discouraging and burdensome referred in particular to the demanding and time consuming nature of their work.…”