Nurses' experiences in assessing decision-making capacity of older patients

A qualitative study was undertaken to explore and describe nurses' experiences in assessing decision-making capacity of patients over age 65 years. Their experiences with surrogate decision-makers were also described including specific health care decisions for which surrogate decision-makers were sought. An interview guide was developed during meetings between the investigator and a moderator. The questions were validated through a taped group discussion with three nurses. During a peer debriefing between the moderator and the investigator, the interview questions were determined to be appropriate for obtaining desired information. Taped interviews were then conducted with 14 additional nurses. Data analysis procedures included open coding and emergent category designation. Trustworthiness was established through tests of credibility, transferability, dependability and confirmability. Triangulation was achieved and a chain of evidence was maintained through interview transcripts, field notes, and a reflexive journal. Findings indicated that nurses recognized the need for ongoing capacity assessments and were comfortable in their own skills of capacity assessment. They described the importance of good communication especially when assessing patients' understandings of their own situation and in observing interactions between patients and others as part of the capacity assessment. Nurses were willing to seek out surrogates and keep them informed and they cautioned against stereotyping patients due to their age. Implications for practice and education include teaching bedside capacity assessment as a part of nursing education programs and increased emphasis on development of good communication skills. Implications for further research point to the need to continue validation efforts of existing bedside capacity assessment tools.