CONSTANTLY NEW CHALLENGES FOR NURSES

Abstract: ABSTRACT Introduction: The number of patients treated in inadequate hospital wards is increasing. Elderly and fragile patients with medical conditions are particularly vulnerable for being placed in inadequate hospital wards. They also run a twice as high risk of health-related complications and increased mortality. RNs obtain specific knowledge by working on specific wards. However, RNs’ experience of caring for outliers seems relatively unexplored, as few studies explore RNs’ experiences in giving nursing care to outliers. Aim: The aim of the study was to explore RNs’ experience of giving care to outliers with medical conditions at a university hospital in Sweden. Method: An interview study with 14 RNs from medical and surgical wards were conducted by semi-structured interviews. The inclusion criteria were that they had worked as an RN for minimum two years and had experience of outliers. Data were collected between December 2016 and January 2018. The interviews were transcribed and analyzed using conventional qualitative content analysis to identify categories and themes according to the aim of the study. Result: One overarching theme emerged: The interviewed nurses experienced that outliers’ medical and nursing care was delayed and therefore hospitalization was prolonged. The informants’ experience is substantiated by five main categories: Inadequate information from ER to the ward leads to concern, Nursing interventions are performed later and lead to a sense of powerlessness, Unavailable drugs lead to delayed or no drug administration, Patients on inadequate wards do not receive proper information, and The RN does not know when the patient is ready for discharge planning. Conclusion: RNs described their experience of caring for outliers as an obstacle course and that this risks prolonged hospitalization. They are not equipped to make the most appropriate decisions, as they have other specific knowledge than the specific needs of outliers, and as a result, care is not given. Keywords: outlier, registered nurse, experience, qualitative study, conventional content analysis, care undone, patient safety.