Investigating and transforming cultures to enhance nursing care of older adults in hospital settings

• Main Author: Laird, Elizabeth Ann
• Format: Dissertation
• Language: English
• Published: Ulster University 2016

Background: It is important that when older adults are admitted to hospital wards, they feel valued, and receive compassionate and respectful care. There is an impetus on nurses to explore their practice and investigate and appraise ways of working that will lead them beyond foundational care delivery towards informed person-centred practice. Aim: This thesis aimed to investigate and transform cultures to enhance nursing care of older adults in hospital settings. Design and methods: The thesis presents a selection of 3 studies (generating 5 papers) from the author's published works for enhancing nursing care of older adults. The designs included appreciative inquiry, secondary qualitative data analysis, participatory action research, systematic practice development and narrative enquiry. At the core of each design is the premise, that context and human behaviour cannot be interpreted in isolation. That linkage grounds the studies in social critical theory and resonates through the approaches and processes selected for methods and analysis of the data. The integrated Promoting Action on Research Implementation framework (i-PARIHS) was used to focus indepth discussion on contexts, innovation, recipients and facilitation for knowledge uptake into practice for transforming cultures of care. Summary of Findings: The key findings are 1) the importance of facilitation for generating a shared learning culture in hospital wards for the exploration and investigation of practice, 2) the exposure of vulnerability in the care experience of older adults, and 3) the conveyance of a disempowered space shared by older adults and their nurses. The thesis demonstrates that a range of research designs rooted in critical social theory are appropriate for enabling nurses to explore, investigate and transform cultures to enhance ways of working for nursing older adults in hospital settings. Implications of the work: Implications have been drawn for further refinement of the iPARIHS framework, for future research, for nursing practice and nurse education. A recommendation is the embracement of 'co-innovators' in knowledge uptake into practice research. The implication for nursing practice is the contribution of transformational leadership and facilitative processes for enabling nurses and interdisciplinary teams to collaboratively explore issues in practice and make ready workplace culture for change. 'Hearing all voices', the epistemological stance of the thesis and 'discourse is action', a tenet of critical social theory have implications for the approaches that would generate a shared learning culture in the pre-registration nursing curriculum.