Journal
JOURNAL OF CLINICAL NURSING
Volume 24, Issue 11-12, Pages 1622-1629Publisher
WILEY
DOI: 10.1111/jocn.12763
Keywords
cognitive impairment; confidence; emergency care; older adults; self-efficacy; sociology
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Funding
- Emergency Care Institute of New South Wales
- Agency for Clinical Innovation
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Aims and objectivesThe study aimed to explore the practice of care among emergency nurses caring for older persons with cognitive impairment and who presented in pain from a long bone fracture, to highlight nurse confidence and self-efficacy in practice. BackgroundCognitive impairment is an issue increasingly facing emergency departments. Older persons with cognitive impairment have complex care needs, requiring effective clinical decision-making and provision of care. Nurse confidence and self-efficacy are critical to meeting the necessary standards of care for this vulnerable patient group. DesignA multi-centre study. MethodsThe study was undertaken across four emergency departments in Sydney, Australia. Sixteen focus group discussions were conducted with 80 emergency departments of nurses. ResultsFour main themes emerged: confidence and self-efficacy through experience; confidence and self-efficacy as a balancing act; confidence and self-efficacy as practice; and confidence and self-efficacy and interpersonal relations. ConclusionsOur findings demonstrate that confidence, self-efficacy and reflexivity enabled the delivery of appropriate, timely and compassionate care. Further, confidence and self-efficacy within nursing praxis relied on clinical experience and reflective learning and was crucial to skill and knowledge acquisition. Relevance to clinical practiceOur research suggests that confidence, self-efficacy and reflexivity need to be developed and valued in nurses' careers to better meet the needs of complex older persons encountered within everyday practice.
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