Exploring nurses’ experiences of caring for older adults with depressive symptoms in China: a qualitative descriptive study

Depression and depressive symptoms among older adults impose a substantial health and service burden on individuals, families and the healthcare system in China, yet they often remain unrecognised due to symptom concealment, low help-seeking and limited public awareness. Hospital nurses have frequent and sustained contact with older adults and may hold unique advantages in recognising depressive symptoms, although their actual experiences and challenges remain underexplored. This study aimed to examine hospital nurses’ experiences of recognising, interpreting and responding to depressive symptoms among older adults in a tertiary general hospital in eastern China. A qualitative descriptive design was adopted. Eight semi-structured focus group interviews were conducted with 48 registered clinical nurses working in inpatient departments of a tertiary general hospital in eastern China. Data were transcribed verbatim and analysed using reflexive thematic analysis. Three themes were generated: “It’s very hard to detect”-Understanding and making sense of depressive symptoms; “They just don’t want to say it out loud”-Understanding the perspectives of older adults and their families; and “We seem to be in a kind of avoidant state”-Balancing person-centred care and organisational constraints. The findings show that although nurses have frequent contact with older adults in routine care, their ability to recognise depressive symptoms was shaped by limited knowledge, challenges in communication with older adults and families, and organisational barriers. Strengthening mental health education for general hospital nurses, improving family engagement and establishing clearer organisational procedures may enhance the recognition, interpretation and response to depressive symptoms among older adults in general hospital settings.