Nurses' experiences of caring for the older adult in the emergency department: A focused ethnography

• Focused ethnography.
• Findings-culture of ED nurses-ongoing priority setting and pressured care (throughput).
• Lack of fit between ED culture and older adults.
• Default-priority setting.
• Default placed older adults at risk of substandard care.
• Nurses tried to counter culture in small ways.

The purpose of this study was to explore nurses' experience of caring for the older adult within the ED. This focused ethnographic study used a combination of semi-structured interviews and non-participant observation. Seven registered nurses participated, detailing their experiences of caring for the older adult in the ED. Data were transcribed verbatim and analyzed thematically. Findings revealed three themes: the culture, which focused on priority setting and throughput of patients, lack of fit between the older adult and the ED, and managing lack of fit. Nurses relied on a default orientation of priority setting, recognizing this put the older adult at risk of substandard care. Lack of fit was accentuated by the need to ‘puzzle through’ atypical presentations of many older adults. It is concluded that consideration needs to be given on how to mitigate lack of fit and how to support nurses to give the care the older adult requires.