Skilled compassionate staff work in effective teams
Knowledge and skills in care of older patients, particularly those with cognitive impairment, were seen as important for all hospital staff.
“Even from the people who work in the ward who are going to handle an older person, who are going to transfer an older person; how are they going to deal with an older person if he has dementia when he needs to move from A to B or he needs to have his meds? So everyone needs to have some sort of training.” P17, geriatrician, academic
Compassion was identified as an important attribute in caring for older people. Experiential learning could enhance compassion, while entrenched ageism, lack of knowledge and mentorship, negative experiences and competing values and demands could erode it.
“I do think that people start with a degree [of compassion] and it can be eroded over time, through experiences of lack of interdisciplinary teamwork, you know, lack of what they see as being important, not being valued.” P3, nurse, manager “They probably don’t think about it… It’s so easy when you work in that environment all the time. You become immune to what goes on” P9 nurse, clinician
Teamwork was discussed as a critical component of care of older inpatients. Respondents identified value and challenges working in multidisciplinary teams (MDT). Good teamwork provided opportunities for sharing information, prioritising workload, mutual learning and peer support.
“Different people bring the different skill mix to the situation…. I actually love the interaction of the team because it really allows us to talk about the aspects of the older person care in a really MDT approach. We know the view of the doctors, the doctors are able to learn the view of ours and I believe that we learn from each other.” P10, AHP, clinician
However, when multiple team members were involved in care there was a risk of overwhelming patients and families with poorly coordinated interactions. Within teams, professional silos could limit communication of important information, create duplication, and prevent individual providers taking responsibility beyond a limited scope.
“I would hear the nutrition assistant or the dietitian come around to the patient…just saying ‘how’d you go with your [breakfast] this morning’. And I thought, what a missed opportunity, because the nurse was there, you didn’t ask the nurse, you walked straight past them.” P3, nurse, manager “I think nurses are very quick to go ‘this is not something I know a lot about so I’ll flick it off sooner than I really need to because I know that there’s somebody more expert in that.”’ P12, nurse, academic
Important enablers for promoting effective teamwork included face-to-face meetings, working together over time to develop trust and shared values, and open discussion of role boundaries.
“[These medical staff] don’t have any rapport with the allied health team… in comparison to teams that might meet three time a week so you’ve got a bit of rapport. You get to understand how they work, and they get to understand how you work… I think with teams that don’t meet and don’t really know each other, that’s really difficult.” P1, AHP, clinician