Care for community-dwelling frail older people: a practice nurse perspective

Aims and objectives. To evaluate care programmes for community-dwelling frail older people from a practice nurse perspective and gain a deeper understanding of their role within the programmes. Background. In response to the increasing frail population, three regions in the Netherlands implemented care programmes, in which a proactive approach is used to identify frail older people in the community and provide them with the appropriate care and support. Design. A constructivist grounded theory approach. Methods. A formative process evaluation was performed, in which study participants were practice nurses (n = 23) focusing on the identification of and care for frail older people in primary care settings. Based on the principles of grounded theory, data were collected via semi-structured interviews and focus groups and analysed. Results. The practice nurses explain that 'building a trusting relationship' with the older person and 'making connections' between older people, family and other professionals are key elements of good care in the programmes. 'Targeting the wrong audience' and 'providing good care' reflect the doubts and feelings of insecurity the practice nurses have about the screening and selection procedures and their own role and expertise in the programme. Conclusion. According to the experiences of practice nurses, a trusting relationship with the older people is necessary to provide good care. Practice nurses feel they should receive more support and education to conquer issues concerning social problems in frail older people. Moreover, practice nurses considered the screening and selection procedures to be unsuccessful in identifying frail older people who do need care. Relevance to clinical practice. A trusting relationship should be given high priority in the care for community-dwelling frail older people. To improve the care programmes, screening and selection procedures need adjustments. Practice nurses should receive more support in dealing with older people with psychosocial problems.