Nursing Assignment: Quality Of Care Services For Older People
Write a nursing assignment addressing the following questions:
Answer the question below:
- How does direct ageism differ from indirect ageism attitudes?
- How does direct ageism differ from indirect ageism (i.e., age discrimination)? Please give an example.
Please review case study below and answer the question(s) below.
This case study will describe three different perspectives of a fictitious event in a busy acute hospital ward (Adapted from Edvardsson & Nay, 2009).
Perspective 1- RN (33-year-old, female)
We have been extremely busy; the registrar has been up all night; the phones have not stopped ringing; two nurses have rung in sick; and the ward is crowded. One of the older patients, Mrs R. started to wander about, became aggressive, verbally abusive, impossible to shower and was constantly trying to get out of bed all night. We simply had no option but to restrain her to stop her hurting herself. However, she nearly strangled herself in the rails, so we sedated her and removed the restraints. When she woke up, she fell over the end of the bed and now has a major bump on her head. The family is furious and said we should have called them earlier, but we just didn’t have time. Person-centred care… who has time for that?
Perspective 2 – Mrs R (86 years old patient)
My name is Mrs R. I am a holocaust survivor and I have awful pain; I don’t recognise anything or anyone in this dreadful place. Everyone is on the run and there are loud noises everywhere. I do know that if you go to the shower you don’t come back. I need to pass water, but they have tied me down and I can’t get to the lavatory. They say the doctor is coming but I’ve heard they do awful experiments so I must try to escape.
Perspective 3 – Son (52 years old)
I am Mrs R. son - I have told them and told them to call me if Mum has a problem – now I get here and find her all bruised and bleeding. She is never angry at home, but they rush her and don’t listen. She is very dignified and would be mortified to wet the bed, but they don’t seem to care. Is this what quality care is all about?
- What did you notice about these perspectives?
- Have you encountered any of these perspectives, in your role as a student nurse, when caring for an older patient in a busy hospital ward?
- If yes or no, how do you think these perspectives could be more aligned?
The Royal Commission and Media reports of the Aged Care System, regularly use the term “Aged Care Crisis”. There are many complaints and reports of elder abuse across the health care system where basic standards are not being met. One reason identified is lack of support and training for staff. The following image was used to inform the public of the issues in caring for the older person.
- What are the positive and negative aspects of publishing images such as this?
- As a member of the public: What are your impressions and judgements of Nurses after seeing this poster?
- As a Student Registered Nurse who has completed placement, what are your opinions and interpretation of the poster in relation to your experiences of the care provided to older people?
Models of Care are rapidly changing. Currently there is great interest and research into intergenerational models of care.
Review the articles below to aid you in the following discussion.
- What are the beneficial aspects of an intergenerational model of care for the older person and the younger generation?
Please review Learning Activity 1: Case Study in Topic 7, answering the question(s) below.
This case study will examine rights violations as experienced by older people in hospitals and in residential care in the United Kingdom. Their perspectives are outlined below.
“An 80-year-old woman […] was seriously sexually assaulted by another resident in 2004. It was reported in the log book but no action taken [...] It was only reported to the president’s daughter in July 2005. She reported the matter to the police.”
“I went to visit my husband on the first day and he is a very private person, he doesn’t like anything to embarrass him and when I went in, he was almost in tears which is not my husband. He said ‘please, please go and get a bottle I am nearly wetting myself’. I rushed out I got a bottle and I said to him ‘Well why didn’t you just ring the nurse’, in my innocence. ’I have for an hour and a half I’ve been asking for a bottle’. Well when I went out [and] told the nurse she said ‘Oh don’t worry we would have changed the sheets’”.
“[…] an older person in a care home who is expressing difficulty with breathing where the care home response is to ignore it or say, “She will be okay” or “he will be okay”, and there is absolutely no access to a GP for three, four or five days and then the care home will present it as being a sudden deterioration. But it is not a sudden deterioration, it is a denial of access to a GP that would not happen if that was a younger person” (United Kingdom: House of Commons, 2007).
- What rights violation of older people do you detect from the three narratives provided above?
- What actions could be taken to address these violations to improve the safety and quality of care for these individuals?
In the literature it suggests that it is time to get real about delivering person-centred care and that healthcare professionals and patients/clients need a change in mindset. To achieve this change, according to McCormack et al., (2015), there needs to be a shift away from person-centred “care” per se to a unified discourse of person-centred “cultures”. With this statement in mind reflect on your own experience of person-centred care in your clinical placements or in personal encounters with healthcare workers and then respond to the following questions and statements.
- Did these experiences match the principles of person-centredness as suggested by McCormack and other authors? Make a list of the principles that did and those that did not.
- Think about the examples you provided and make a list of challenges for yourself to undertake in your next clinical placement.
As per the research on nursing assignment, it is stated that direct ageism takes place when people treat a specific person differently as compared to others due to his or her age (Stypi?ska & Nikander, 2018). This kind of discrimination generally occurs when nurses or other healthcare professionals do not consider dignity and well-being of older people. For example, in a nursing home there was a practice of placing residents in wheel chair irrespective of their ability to walk. It was due to a perception that older people are unable to walk properly and hence, they should be treated differently than others. On other hand, indirect discrimination takes place when a specific rule is applied to every patient; however, this has detrimental impact on some individuals due to their age. It generally happens as older people have different needs than others.
For example, in some Covid-19 cases decisions regarding life-expectancy or quality-of-life are made through assessing extent of disabilities of older people. Older people having some disabilities are placed at disadvantage when it comes to deciding if they would survive Covid-19 or not (Savulescu et al. 2020). However, their specific needs are not taken into consideration. Healthcare professionals end up providing care services that they provide to other people as well.
It is evident from case study that quality of care services for older people is not up to the mark in the hospital especially for older people. According to RN’s perspective, person-centred care is impossible in busy hospital ward and hence, it was impossible for taking care of people like Mrs. R, who was severely sick. RN did not take care of Mrs R by considering her age and provided basic care services that they used to provide to other patients having similar kind of diseases as well. It was a case of indirect-age-discriminatory attitude towards a patient due to her age. As cited by Nilsson et al. (2019), person-centred care is feasible in acute older-care wards and it is necessary for providing quality healthcare services to understand specific needs of elderly people.
However, indirect ageism often prevents nurses to provide need-based care services to older people. From perspective of Mrs R, it could be seen that she was going through a challenging situation and it was requiring special kind of care considering her age. However, she had some beliefs regarding treatment provided by healthcare professionals and these beliefs influenced her attitude significantly. Therefore, it is often not possible for nurses or other healthcare professionals to change someone’s beliefs; however, by providing need-based care services such as by talking and assessing specific needs, they could have dealt with her problem and could avoid the accident (Borglin et al. 2019). From perspective of Mrs R’s son, it is evident that nurses are negligent in taking care of his mother in a proper way that caused her to get hurt. It was due to lack of proper care taken for people with specific needs. However, it is also true that nurses’ jobs are stressful and hence, family members of patients should also be cooperative.
This kind of situation was encountered during an internship with a hospital as a trainee nurse. An individual belonging to 89 years of age was suffering from Dementia. She used to become agitated easily whenever she would not get proper attention from nurses. There were some stressful days, when nurses could not take proper care of that patient due to the huge workload. Person-centred care services are needed in nursing homes and hospitals that deal with older people having specific needs (Nilsson et al. 2019). However, this requires proper cooperation from patients’ families as well. Families should focus on meeting social needs of patients to facilitate their recovery process. In this case, nurses were stressed and negligent as well that worsened patient’s condition.
From nurses’ perspective, the stressful situation caused them to take less care of Mrs.R and this was reason due to which they could not inform her family regarding her health condition. Family members should have been encouraged to meet patient to understand her needs in some cases to avoid accident. Nurses could have divided their tasks properly to handle stress and provide proper care.
Creation of awareness amongst people regarding importance of taking care of aged people
Discrimination will be eliminated from care services
People suffering from ADHD can derive wrong meaning of image and can suffer from emotional-burnouts (Brassine et al. 2020)
Orthodox people can feel disturbed after seeing these images as they can interpret the images in wrong way and they can become emotionally distressed after seeing this type of image
As per nurse’s perspective, this poster will eliminate stereotypes that care service staff can have regarding treatment of aged care people. Apart from this, it can also eliminate indirect-ageism related attitudes. There will be increased awareness regarding significance of need-based care services for aged people
There is an age-discrimination between aged and child care facilities
There is lack of focus on protecting interests of aged people
Intergenerational model aims at building ongoing connection between aged and young generation. This can promote good health of elderly people as it facilitates development of horizontal relationships between two generations (Medium, 2017). For older people it can enhance their self-esteem and hence can have good impact on their mental health. Increased social interaction helps in sleep management amongst older people having problems such as Dementia and slows down their decline in cognitive impairment. As it facilitates two-way learning, it helps in developing new skills amongst people belonging to younger generation. A social gap is filled especially for children who do not have grandparents and it has a good impact on mental health of young people.
Two right violations have occurred in first case and these are “Human-Rights, 1998” and “Right to safety from abuse” (Ageuk, 2020). As hospital could not provide a safe environment for elderly people and could not take proper action, they violated these rights.
In second scenario, patient’s “Right to Dignity” has been violated as nurse could not take care of special need of the person when he needed the most. In third scenario, patient’s right to accessing proper care has been violated, as there was an indirect-ageism attitude towards older person.
A safe environment could be created by recruiting efficient and trustworthy staff who would monitor patients’ safety. There should be a system for taking stringent action against person committing this kind of crime.
Staff should be provided with ethics training after recruitment to make them aware of importance of complying with patient’s right-to-dignity to provide good quality healthcare services to patients.
Person-centred healthcare culture should be developed for ensuring equality in healthcare system. Nurses should undergo sensitivity training so that they can cope with this system properly.
Principles that matched
Having sympathetic-presence can ensure satisfaction to clients
Enhanced engagement with patient and their families can provide them with feelings of well-being
Ensuring accessible services can create proper culture
Principles that did not match
Working with beliefs of patients can improve belongingness
Shared decision-making can improve quality of services
It will not always be possible to engage patients in decision-making as due to poor knowledge regarding a specific health concern, patients often end up arguing with healthcare professionals and it often leads to wrong decision-making (Hawley & Morris, 2017). Engagement with family can also be challenging when they are unresponsive or overbearing. For instance, while working as an intern it was experienced when patient with Dementia needed social support and his family was unresponsive in doing so. Working with patients’ beliefs would not be possible all the time as they can develop wrong belief regarding their treatment.
Ageuk, 2020. Safeguarding older people from abuse and neglect. Retrieved on 7th November 2021 from https://www.ageuk.org.uk/globalassets/age-uk/documents/factsheets/fs78_safeguarding_older_people_from_abuse_fcs.pdf
Borglin, G., Räthel, K., Paulsson, H., & Sjögren Forss, K. (2019). Registered nurses experiences of managing depressive symptoms at care centres for older people: a qualitative descriptive study. BMC nursing, 18(1), 1-12. Retrieved from https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-019-0368-5
Brassine, J., Van den Eynde, J., Hubble, T. R., & Toelen, J. (2020). Digital images of pediatric mental disorders do not accurately represent the conditions. Heliyon, 6(9), e05017. Retrieved from https://www.sciencedirect.com/science/article/pii/S2405844020318600
Hawley, S. T., & Morris, A. M. (2017). Cultural challenges to engaging patients in shared decision making. Nursing assignment Patient education and counseling, 100(1), 18-24. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5164843/
Medium (2017). Humanitas: not just a ground-breaking ‘healthcare model’ but a whole new approach to community design. Retrieved on 7th November 2021 from https://medium.com/meaning-conference/humanitas-not-just-a-ground-breaking-healthcare-model-but-a-whole-new-approach-to-community-21a8dea0d0b1
Nilsson, A., Edvardsson, D., & Rushton, C. (2019). Nurses’ descriptions of person?centred care for older people in an acute medical ward—On the individual, team and organisational levels’. Journal of clinical nursing, 28(7-8), 1251-1259. Retrieved from https://www.researchgate.net/profile/Carole-Rushton-2/publication/329686308_Nurses'_descriptions_of_person-centred_care_for_older_people_in_an_acute_medical_ward-On_the_individual_team_and_organisational_levels'/links/5fbb7019458515b797628ec7/Nurses-descriptions-of-person-centred-care-for-older-people-in-an-acute-medical-ward-On-the-individual-team-and-organisational-levels.pdf
Savulescu, J., Cameron, J., & Wilkinson, D. (2020). Equality or utility? Ethics and law of rationing ventilators. British Journal of Anaesthesia, 125(1), 10-15. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7167543/
Stypi?ska, J., & Nikander, P. (2018). Ageism and age discrimination in the labour market: A macrostructural perspective. In Contemporary perspectives on ageism (pp. 91-108). Berlin: Springer, Cham.