Clinical decision-making process for early nonspecific signs of infection in institutionalised elderly persons: experience of nursing assistants

Aim: To illuminate nursing assistant's experiences of the clinical decision-making process when they suspect that a resident has an infection and how their process relates to other professions.

Background: The assessment of possible infection in elderly individuals is difficult and contributes to a delayed diagnosis and treatment, worsening the goal of good care. Recently we explored that nursing assistants have a keen observational ability to detect early signs and symptoms that might help to confirm suspected infections early on. To our knowledge there are no published papers exploring how nursing assistants take part in the clinical decision-making process.

Design: Explorative, qualitative study.

Setting: Community care for elderly people.

Participants: Twenty-one nursing assistants, 22-61 years.

Methods: Focus groups with verbatim transcription. The interviews were subjected to qualitative content analysis for manifest and latent content with no preconceived categories.

Findings: The findings are described as a decision-making model consisting of assessing why a resident feels unwell, divided into recognition and formulation and strategies for gathering and evaluating information, influenced by personal experiences and preconceptions and external support system and, secondly, as taking action, consisting of reason for choice of action and action, influenced by feedback from the nurse and physician.

Conclusion: Nursing assistant's assessment is based on knowing the resident, personal experiences and ideas about ageing. Nurses and physician's response to the nursing assistant's observations had a great impact on the latter's further action. A true inter-professional partnership in the clinical decision-making process would enhance the possibility to detect suspected infection early on, and thereby minimize the risk of delayed diagnosis and treatment and hence unnecessary suffering for the individual.

Relevance to clinical practice: In order to improve the clinical evaluation of the individual, and thereby optimise patient safety, it is important to involve nursing assistants in the decision-making process.