Daily observation of cognitive functioning in hospitalised patients on acute geriatric wards.

Abstract

BACKGROUND: Daily observation by nurses of the cognitive function of patients is of high ecological validity because cognitive functioning is observed in a natural setting around the clock. AIM: To evaluate why and how geriatric nurses observe the cognitive functioning of their patients. DESIGN: Survey. METHODS: A self-developed questionnaire was administered to a purposeful sample of nurses working on geriatric wards of seven acute care hospitals. The questions were open-ended. Data were analysed through content analysis. RESULTS: The questionnaire was completed by 97 nurses (response rate 77%). Categorisation of the many objectives reported by the nurses revealed four themes: to tailor nursing interventions (51%), to determine discharge arrangements (46%), to support medical diagnosis and therapy (43%) and to map specific elements of functional capacity (34%). Nurses reported also many different domains to observe (mode 2; range 0-7), only 73% of which were actual cognitive domains. The most commonly mentioned cognitive domain was psychomotor behaviour (63%), followed by executive functions (48%), language (37%), attention (33%), thinking (25%) and consciousness (20%). CONCLUSIONS: Geriatric nurses not only made daily observations of their patients' cognitive functioning to support medical diagnoses, but also to guide nursing interventions and determine discharge arrangements. The assessment domains varied fairly widely, because the participants' understanding of the concept cognitive functioning was vague, incomplete and often incorrect. RELEVANCE TO CLINICAL PRACTICE: This is the first study that investigated why geriatric nurses make daily observations of their patients' cognitive functioning. In addition, we explored their understanding of the concept of cognitive functioning. Based on the fact that the content of an assessment is determined by its aim, the objectives to perform daily observations have to be clear and stated explicitly. To observe patients in an unambiguous way, it will be necessarily to develop a validated observation scale.