Acute Care

Acute care settings are not neutral and reflect relations of power that have come to be embedded in what is considered valid knowledge and what actions are considered appropriate (Cheek, 2004; Liaschenko, 1994) From an EDIA perspective…

Roles? Patient – doctor

What is acute care?

Acute care hospitals are understood to be places of cure, meaning that holistic or rehabilitative interventions can be deemed less important in acute care settings (Cheek, 2004; Sellman, 2009). This may affect how nurses care for older patients who have needs that are not considered curable, such as chronic conditions that complicate care and impede discharge. The acute care environment is further characterized by a focus on technology and providing technical care is prioritized over what is considered basic nursing care, that of providing bodily care to older people (Cheek & Gibson, 2003; Dahlke, Phinney, Hall, Rodney, & Baumbusch, 2014; Daykin & Clarke, 2000). Older people are not “typical” patients in acute care; by typical I mean the fictional, standard patient to which acute care is generally oriented. This type of patient would have one medical issue to care for and responds in an expected manner to the prescribed treatment (Parke & Hunter, 2014).

The acute care context is focused on risk aversion, including managing the safety risks of older patients, and contributes to practitioners focusing their efforts on minimizing risk rather than other care work (Calnan et al., 2013; Dahlke et al., 2014). Additional foci of care are often on basic function and physiological issues (Macieira et al., 2020). Care can also differ between the ward one is admitted on and between institutions. As such, acute care settings are not seen as appropriate places for older people despite older people comprising the main population of acute care (Cheek, 2004; (Calnan et al., 2013). Skills gap in caring for older people (Calnan et al., 2013) Minimal opportunities to gain geriatric knowledge during professional training or development (REF).

Older people in hospitals

Indeed, the care of older people has been described as the core business of health care (Cheek, 2004; Croucher, 2010). In Canada, older people over 65 years account for 40% of acute care hospital stays (Canadian Institute for Health Information, 2011). The numbers of older people in acute care will likely increase, as demographic trends show that the proportion of older people in the general population is growing. Currently, older people account for 15.3% of the Canadian population, and by the year 2063 it is estimated this will increase to 25% (Statistics Canada, 2014). These numbers support the need for research to better understand the care of older people in hospital.

“Foucault develops the concept of ‘the medical gaze’, describing how [healthcare providers] modify the patient’s story, fitting it into a biomedical paradigm, filtering out non-biomedical material. A ‘gaze’ is an act of selecting what we consider to be the relevant elements of the total data stream available to our senses.” (Misselbrook, 2013)