Understanding assessment on a hospital ward for older people: A qualitative study.

AIM: To explore assessment on a hospital ward for older people from the perspectives of patients and healthcare professionals. DESIGN: A qualitative study drawing on grounded theory was undertaken between February 2015 - January 2016. METHODS: Interviews with 15 patients and 22 healthcare professionals, a focus group with six healthcare professionals, 45 hr of observation and review of 18 sets of patient notes. Analysis was conducted using initial and focused coding, continuously comparing data, emerging codes and themes. FINDINGS: The core category was navigating, constructed through three themes: containing complexity, networking, and situating the process. Navigating assessment was a complex, flexible, context dependent, and social process where healthcare professionals used a combination of formal, informal, visible, and invisible ways of working. Registered nurses were at the centre of networking and focused on gathering and sharing information in the multi-disciplinary team, whilst patients had a passive role despite a variety of preferences about their involvement. CONCLUSIONS: Navigating the assessment of older people is contextually situated, includes networking and a professional focus on containing complexity. This process may be enhanced by: (a) making informal assessment visible to others; (b) developing the nurses' role beyond chasing information towards coordinating care; and (c) asking patients and acting on how they would like to be involved in decision-making. IMPACT: Acknowledging that navigating assessment is a social, flexible and complex process, including different ways of working to meet patient needs, may enhance the usability of current assessment guidelines and their development.