Nursing Assignment: Quality Of Medical Care 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.
Nursing Assignment Question 1
Ageism is related to the stereotypes and prejudices related to discrimination towards oneself or others. Direct ageism occurs when people are treated in lesser favourable conditions in the workplace due to the presence of protected characteristics. The discrimination is typically based on age which can be systematic or casual in nature. The attitudes of indirect ageism differ from direct ageism as they occur in workplaces where rules and regulations are neutral and can apply to anybody. (Alderslade, 2019). People who are withholding the benefits of training employees based on their age are also considered examples of direct discrimination. Whereas in the case of indirect discrimination the people are not singled out by the discriminators and the process often results out of informal arrangements, practices, and procedures.
Examples of indirect ageism or discrimination can be contract clauses that apply to all the employees of organizations. Although the contract clauses are neutral and uniform, they can be disadvantageous to certain people like mothers who need to make arrangements related to childcare. This factor can be considered as indirect discrimination for a certain section of people. Employees who need to work on a certain date that is a religious festival can be applied to all employees; however certain people who follow religious beliefs may be disadvantaged due to the uniformity in the working process (Alderslade, 2019).
The three perspectives have some common views regarding the chaos and mismanagement in a busy hospital ward. The three patients that are considered in the three perspectives have mental-related conditions and illnesses for which they are admitted to the hospital (De la Fuente-Núñez et al., 2021). The hospital staffs are too busy to provide personalized care to the patients for whom the family members are very anxious and worried. As result mismanagement in the hospital setting is severely affecting the proper and timely treatment of the three patients considered in the case studies.
The perspective discussed in case study one has some similarities with a personal encounter as a nursing student. There was a patient who was around in her 40's who was very verbally abusive. She was constantly getting out of her ward and had to be forcibly brought back to her bed. She had her restraints on and after her sedation; restraints were not opened by the senior nurses. When she woke up and became violent once again, she did not fall from her bed as in the case of the first perspective. This timely act of common sense saved her from falling and getting injured.
In a time of chaos and crisis in a hospital ward, the patients cannot get personalized care (Drury et al., 2016). Therefore, the hospital administration has to provide either adequate recruitments of the nurse as compared to the patient ratio or properly train the nurses to do multitasking as it is a crucial part of professional nursing. The reduction in negligence on behalf of the nurse can significantly help the hospital align the perspectives that have been causing trouble to the patients.
The positive aspects of publishing images like these can influence the mindset of the common people. It can raise the awareness and consciousness levels of the legal administrative system and the common people. People can get laws related to old-age care and facilities that can benefit the aged people in Australia. The negative aspects of publishing these images are the impact that can be created on the minds of the aged people. They can get demoralized; demotivated in seeing these images and this can also trigger the symptoms of depression in aged people further triggering mental illnesses (Moore et al., 2016). Therefore, these images can act as a catalyst in deteriorating the mental health and wellbeing of aged people.
These posters can provide a mixed response to a registered nurse as a member of the public. They can feel a sense of partiality that prevails in the legal system based on ageism and age discrimination. The elderly people are deprived of the benefits related to the protection of human rights. However, as children have laws that can be used to protect their discrimination, the aged people can also get some laws regarding their preservation of human rights shortly.
As a registered nurse practicing in the hospital settings there should be laws that equalize children and aged people as they are considered the most vulnerable age group in the society (www.ageuk.org, 2017). The elderly are mostly deprived of the benefits and the personalized care and treatment they need to receive in healthcare settings. These can be considered as the expectations of registered nurses in Australia.
There are many benefits of intergenerational models of care for the elderly and children. These models can significantly energize older adults and provide them with a sense of purpose while sharing their skills and experiences. The sense of isolation for the elderly is also relieved and their depression symptoms are also reduced considerably. The intergeneration model implementation on the children can raise their attainment by proper reading and communication aspects. The models help in transforming the attitudes of children and building proper relationships between the elder and younger people. They can also bond through experiences and also by solving tough issues related to health improvement and promotion of social mobility for reducing crime and waste (Yates, 2017). It also helps in shaping the overall future of the younger generation which creates a lasting impression on the three generations.
The UK is responsible for protecting aged people from human rights violations. These three incidents provided in the narratives depict violations related to Article 14 that prohibits discrimination and Article 3 which is related to the prohibition of torture, inhuman and degrading treatment. The safeguarding of human rights related to the safeguarding of age discrimination provides a shield to the aged residents of the UK who receive hospital treatment. The European Convention on Human rights control and Protecting the rights of the aged people in hospital or home care settings.
The address and mitigation of the violations regarding improvements in safety and quality are controlled by the Equality and Human Rights Act of 2010 and the Human Rights Act of 1998 that are responsible for legal implications related to unfair treatment of aged individuals (Ye et al., 2020). Apart from the legislations, certain actions can be provided to address the violations like the provision of a national accreditation scheme for the training providers who want to offer care training. The regulations should also contain the minimum standards for supervision and monitoring and the training quality should also be mapped according to ratings of regulated services. Lastly, the service providers should actively invest and participate in supporting the leadership development of management employees.
The principles of person-centeredness are deeply rooted in the various human rights values according to WHO. The principles of human rights and dignity, non-discrimination, participation and empowerment, equity and access along with the partnership of equals can be considered as the principles that are applicable in the case scenarios mentioned. The various incidents related to the hospital settings and the negligence of the registered nurses provide a detailed overview of the mismanagement of the nurses (Mc Cormack et al., 2015). However, the principles related to human rights and dignity, and non-discrimination are evident in the case studies and the principles of participation and empowerment along with access and equity are not evident in the case studies. The research and development work of Mc Cormack matches the principles of the case studies that are mentioned in this paragraph.
As a registered nurse the constraints related to nursing, reduced employee experience and high workload and pressure of the nurses contribute to the challenges of developing effective person-centred services to patients (Mc Cormack et al., 2015). Unsupportive attitudes and attributes of co-workers and employees along with the stereotype approach of experienced employees also restrict person-centered interventions in the nursing profession.
Alderslade, L. (2019, June 6). New study houses university students and aged care residents together. Aged Care Guide. https://www.agedcareguide.com.au/talking-aged-care/new-study-houses-university-students-and-aged-care-residents-together?__cf_chl_captcha_tk__=nAsBIiGVhrLBmzfKwsFYZfpRlBiltc7zO8UFfR_ky7U-1636353140-0-gaNycGzNCNE
De la Fuente-Núñez, V., Cohn-Schwartz, E., Roy, S., & Ayalon, L. (2021). Scoping Review on Ageism against Younger Populations. International Journal of Environmental Research and Public Health, 18(8), 3988. https://doi.org/10.3390/ijerph18083988
Drury, L., Hutchison, P., & Abrams, D. (2016). Direct and extended intergenerational contact and young people’s attitudes towards older adults. British Journal of Social Psychology, 55(3), 522–543. https://doi.org/10.1111/bjso.12146
Mc Cormack, B., Borg, M., Cardiff, S., & Dewing, J. (2015, September). Person-centredness – the “state” of the art. Https://Www.researchgate.net/Publication/329762163_Person-Centredness_-_the_’State’_of_the_art. https://www.researchgate.net/publication/329762163_Person-centredness_-_the_’state’_of_the_art
Moore, L., Britten, N., Lydahl, D., Naldemirci, Ö., Elam, M., & Wolf, A. (2016). Barriers and facilitators to the implementation of person-centred care in different healthcare contexts. Nursing assignment Scandinavian Journal of Caring Sciences, 31(4), 662–673. https://doi.org/10.1111/scs.12376
www.ageuk.org. (2017). Briefing: Human rights of older persons and their comprehensive care. https://www.ageuk.org.uk/globalassets/age-uk/documents/reports-and-publications/reports-and-briefings/equality-and-human-rights/age-uk---human-rights-of-older-persons-and-their-comprehensive-care---july-2017.pdf
Yates, E. (2017, June 22). Humanitas: not just a ground-breaking “healthcare model” but a whole new approach to community…. Medium. https://medium.com/meaning-conference/humanitas-not-just-a-ground-breaking-healthcare-model-but-a-whole-new-approach-to-community-21a8dea0d0b1
Ye, B., Gao, J., Fu, H., Chen, H., Dong, W., & Gu, M. (2020). How does ageism influence frailty? A preliminary study using a structural equation model. BMC Geriatrics, 20(1). https://doi.org/10.1186/s12877-020-01749-8