Frailty means falling between the cracks: A qualitative study exploring emergency nurses' understanding of frailty and its use in informing clinical decision-making related to acuity, care, and disposition

Abstract

The purpose: Of this study was to understand emergency nurses' use of frailty to inform care, disposition decision-making, and further assessment.

Methods: A qualitative, descriptive, exploratory approach was used. Field notes from group discussions held during a conference presession on frailty and post-session evaluation data were analyzed.

Results: Two common ideas threaded these discussions: frailty as vulnerability to "falling through the cracks" and that of an iceberg. Participants stressed the broad and expansive ramifications of frailty, and lack of structure/process to accurately describe, quantify, and utilize the concept. Participants described issues of physical and emotional/social fragility, including being unable to complete activities of daily living independently; also of concern were the patients' social determinants of health and financial challenges.

Conclusion: The conceptual understanding of frailty encompassed physical, social, cognitive, and access deficits. Emergency nurses are aware of this concept and would conduct formal frailty screening if provided with training, time, and resources.

Keywords: Clinical decision-making; Emergency nursing; Geriatrics; Older adults; frailty.