Assessing basic needs in frail older persons calls for aesthetic nursing skills: An ethnographic approach

Background: Despite research on caring for older persons' basic needs, a number of hospital admissions occur which had been preventable, given the proper attention to caring for the basic needs. Literature show that caring for the basic needs of frail older persons can be complicated if they are suffering from chronic diseases and complex functional impairments. A starting point for an exploration of this complexity is the identification of frail older persons' basic needs

Aim: To explore the challenges in nursing assessment of basic needs when the older persons' frailty also implies impressive and expressive difficulties. Method: We used Spradley's theory of participant observation. Data were collected from three older persons' individual assessment meeting, followed by individual interviews with the nurse. Field notes and transcribed dialogues from the assessment meetings and interviews were analyzed systematically in four steps.

Findings: Very limited input from the frail older persons characterizes the assessment. The nurses gave ample time and listened patiently to the older persons' voices to understand his or her limited verbal and nonverbal expressions. Using different types of questions, answers, body language and interpretations the nurses ensured that they had heard correctly and understood the older persons' remarks and answers. This revealed two themes: Patiently eliciting the older person's voice, and Empathic listening piecing fragments together to form an understanding.

Conclusion: When patient age and frailty implies impressive and expressive challenges, the nursing assessment of basic needs requires well developed nursing skills to create a facilitating setting that involves the frail older person. The nurse elicits patiently the older person's voice, and listens empathically to piece fragments together to form an understanding. Using imagination and improvisation trying out different solutions, the aesthetic nursing skills are seen prominent though related to the empiric-, ethic-, and personalskills. This enabled the nurses in enhancing the frail older