Managing personal integrity: the process of hospitalization for elders

Background. Although, in the United States of America (USA), 40% of people aged 75 years old and older are hospitalized each year, the literature does not provide insight into their perspectives on hospitalization. Aim. The study was designed to illuminate the experience and behaviours of hospitalized elders, discover the meaning of that experience for them, and develop a substantive theory that could explain the social processes in which elders engaged while hospitalized. Method. Interviews and participant observation data were used to develop a grounded theory. Participants had to be at least 75 years old, speak English, have been admitted to the hospital for medical (non-surgical) reasons, and be able to give informed consent. The elder, a family member, and a registered nurse caring for the elder were interviewed. Two-hour periods of observation were conducted throughout the elder's hospital stay. Computer-assisted data analysis included open, axial and theoretical coding. Techniques to improve the trustworthiness of the research included persistent observation, participant checking, a peer research support group and an audit conducted by an expert gerontology nurse researcher. Findings. Hospitalization was characterized as a process beginning when an alteration in health is identified and continuing through to the process of adjusting to returning home. Personal integrity was found to be a dynamic, intrinsic quality of the self, composed of health, dignity and autonomy. During hospitalization, elders used strategies to manage their personal integrity. At first, elders focused on strategies relating to health and then moved on to dignity and, finally, autonomy. Conclusion. Hospitalized elders choose how they will interact with health care providers and the actions they will take to manage their health, dignity and autonomy. The findings have implications for developing nursing care and for further research.