ArticleBMC nursing2026
Structural determinants in quality of care for older adults: a nursing perspective on medical services - qualitative findings from focus group discussions in Germany.
Article in BMC nursing, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAging populations, multimorbidity, and rapid medical progress have expanded treatment options in old age, but also intensified ethical and organizational challenges in everyday care. Little is known about how nurses, as key frontline professionals, experience these structural developments specifically in the context of medical and nursing care for older adults in Germany. Therefore, this study aimed to examine how nursing staff perceive structural conditions in the German healthcare system and their effects on medical and nursing care for older patients.
methodsThis study employed a qualitative analysis of five focus group discussions with 28 nurses from hospitals, nursing homes, and home-based nursing services in Germany. Participants with diverse qualifications and work settings were purposively and conveniently sampled, and discussions were stimulated by case vignettes on elective surgery and life-prolonging interventions in very old age. Data were analyzed using Kuckartz's Qualitative Content Analysis.
resultsNurses described medical progress as simultaneously enabling better symptom control, mobility, and end-of-life care, while also prolonging phases of frail survival with high care dependence. They reported strong treatment pressures and financially driven incentive structures that foster overtreatment and can conflict with older patients' wishes and perceived quality of life. Chronic staff shortages and time constraints led to "shortcuts" such as tube feeding or increased use of psychotropic medication, which were experienced as undermining person-centered care and professional ethics. Across settings, nurses highlighted a loss of professional influence in medical decision-making, feelings of powerlessness, and moral distress linked to implementing decisions they had not shaped but were responsible for carrying out.
conclusionsFrom a nursing perspective, good medical care in old age depends not only on technological advances and geriatric expertise but also on structural reforms of financing, staffing, and decision-making processes. Strengthening nurses' autonomy, involvement in treatment decisions, and ethical support within interprofessional teams may help align medical interventions more closely with older people's concepts of a good life and a good death. GERMAN CLINICAL TRIALS REGISTER: DRKS00027076, 05/11/2021. https://www.drks.de/search/de/trial/DRKS00027076/details .
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