The night-time experience of elderly hospitalised adults and the nurses who care for them : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in nursing at Massey University

Abstract

This thesis is the report of a study into the night-time experience of elderly hospitalised adults and the nurses who care for them. A grounded theory approach was used for the analysis of data and subsequent generation of a theoretical description and partial explanation of patient experiences, nursing actions and nurse-patient interactions. Data were gathered through observation, interview, document audit and literature review; two general medical wards in a large regional hospital were the focus of field methods of data collection. It is argued that the night-time experiences of elderly hospitalised adults are to a large degree dependent on the individual patterns of sleep and waking behaviour of these people in their normal environments. If individualised care is to be given, nurses must be aware of people's usual patterns of behaviour. Nurses working at night engage in a series of complex decisions in the course of their interaction with patients. They work under constraints not present during the daytime, and are highly dependent on cooperation from colleagues on other shifts for information which would enable them to deliver optimum care at night. At the same time, night nurses have access to information from and about patients which could be invaluable to a total assessment of any patient's health state. Considerations of sleep and rest are relevant to nurses working all shifts. The findings of the study have implications in terms of nurses' knowledge of all aspects of sleep; assessment practices; nurse-patient and nurse-nurse communication; nurse-patient relationships at night; ward management; and the interdependence of nurses.