Nurses' clinical assessments of older clients who are suspected victims of abuse: an exploratory study in community care in Norway

Aim and objectives. The aim of this study was to explore how nurses in community care experienced clinical assessment of suspected abuse cases and factors impacting on the assessment process. Background. Elder abuse is a serious problem affecting an older person's health and well-being. A considerable number of older victims of abuse receive health care services. Health professionals, such as nurses in community care, will very likely meet clients suffering from abuse. In Scandinavia, research about older abuse is quite limited. This also applies to research into nurses' clinical assessments of older, abused clients under community care services. Design. Qualitative, hermeneutic approach. Method. Ten nurses were recruited by purposeful sampling and interviewed in-depth. The analysis process was guided by Gadamer's recommendations on understanding and interpreting oral and written text. Results. Three important phases in the clinical assessment were revealed, including the recognition of a possible abuse situation, an information gathering phase and, finally, judgement and conclusion. Two critical factors impacting on the process included the nurse's ability to get into position to perform the necessary observations in the home and the quality of the information gathered about the client's situation. In addition, factors related to the client and the community care organisation influenced the nurses' work and thereby promoted, delayed or interrupted the clinical assessment. Conclusions. Nurses' opportunities to identify older, abused clients might fail unless certain conditions are present that facilitate the clinical assessment. In particular, the involvement of the manager is important, in addition to the presence of alliances in the assessment process. Relevance to clinical practice. The findings indicate the need for a framework that may facilitate the systematic clinical assessment of suspected older, abused clients in community care. Such a framework might ensure the quality of the service provided to victims of abuse.