A holistic approach to the promotion of older hospital patients' health.

PURPOSE To describe how nurses interpreted health promotion related to older patients in a medical hospital ward and the presuppositions for this work. METHODS The study had a descriptive and explorative design. Data were created through participant observation of five nurses and informal dialogues with four nurses working in an infection unit in a small hospital in Norway. The nurses where followed during a period of 6 months. The observations and dialogues were interpreted and transformed into text. This text was analysed with qualitative content analysis and interpreted hermeneutically on three levels: (1) reading the text to get an overview of the themes; (2) systematically separating central patterns; and (3) highlighting the patterns with examples. FINDINGS The nurses' interpretation of health promotion was closely connected to their interpretation of health and holistic nursing. Two main aspects were uncovered in the informal dialogues: a biomedically oriented nursing view and a holistically oriented nursing view. The observations showed that presuppositions, such as waiting for something or somebody, constantly changing situations, complexity and diversity in patient cases, influenced the nurses' work in general and also their focus on health promotion. The nurses balanced between the biomedical and the holistic approach. It seemed to be important for the nurses to be the masters of walking on a tightrope and to have professional clinical competence. CONCLUSION It was difficult to find a clear focus on health promotion. The most visible focus was on diagnosis and treatment, while the more complex and comprehensive situations related to health promotion of older patients seemed to be underprioritized. The phenomenon of 'waiting' may be an important issue for further research.