The Older Person And Supportive Care Essay

Question:

Discuss the RN’s role in Enacting Coordination, Supervision and Delegation of Quality and Safe Functional Care provided by Nonregistered Nursing Staff (ENs and PCAs) in order to Optimise the Functional outcomes of an older resident diagnosed with Dementia.

Answer:

Introduction

Healthcare systems across the globe have continued to increase their demand due to the increasing number of needs among the population. As the demand increases, the concerns for quality health care also increase and especially among the aged population, who as they get older they face increasing challenges in their health status. Australian health care system is not an exception of these challenges and it has been subjected to a series of challenges and especially in the provision of quality healthcare, in the adoption of innovative capabilities and adoption of cost-effective care in the future. In his study Ives Erickson provides that the most affected population is the aging as compared to the middle age and the youth.

The aged population has continued to suffer due to increased chronic diseases as they grow old, the increased cost of health care, problems related to technological change as well as the increasing need to improve the equity and accessibility of Australian health care systems (Ives Erickson, Ditomassi, & Adams, 2012). These challenges can be addressed through the contribution of the Australian Nurses who are in most cases poses the experience and are capacitated to meet some of these challenges. The proposed reason for nurses to have a great impact in the transformation of the health sector is because, the nursing profession encompasses a wide range of roles such as delivering health care, patient care coordination, advocating for safety and quality improvements among others. Therefore this essay seeks to provide an understanding of the role of Australian registered nurses in acting coordination, supervision, the delegation of quality and safe functional care in their bid to optimize the functional outcomes of the older resident diagnosed with dementia health condition (Street, M et al. 2015).

Effective nursing practice can only be achieved if the registered nurses exhibit their leadership qualities towards the non-registered nurses and the care assistants (Elliott, K et al., 2015). Leadership in nursing is, therefore, a fundamental pillar in the achievement of effective and quality health care. Many scholars as seen in the case of Salem et al. (2015) have applauded the role of nursing as alliance builders and hence play a vital role in coordinating and motivating all health care teams, patients and their families in support of patient well-being. They can at any time make initiatives to improve the safety and quality of the health care systems. Research also provides that nursing leadership brings about a great depth of experience and expertise as well as understanding in the health sector. They understand the social, economic and political factors affecting the health sector (Salem et al., 2015).


The aged people or patients according to the Australian Nursing council 2015 are cared upon in nursing homes which are generally referred to as Residential Aged Care Facilities. A research by the Aged care Sector, 2015 provides that the health and care needs of the patients or old population living in residential aged care facilities are becoming more complex and acute and other results showing an increase in the number of chronic diseases among the aged population. The Australian Institute of Health and welfare 2016 provides a report which indicates that 50% of the aged population in residential aged care facilities has been found to suffer from dementia, 87% of the aged population required high standards of health care, while 80% of the same population was reported to experience mental related health conditions (Cik Yin et al., 2015).

The increase in the percentage rates of the patients in the residential aged care facilities diagnosed with dementia has increased the need for more health care providers and especially the registered nurses due to their expertise and experience in dealing diverse need of the aged populations. Dementia may not be termed necessary as a disease but a combination of symptoms which are caused by brain disorders. Hesseberg et al. (2016) describes that individuals diagnosed with dementia symptoms may experience problems in thinking or proper coordination and ability to do their normal activities such as washing, eating or getting dressed. The condition may be characterized by a number of symptoms such as inability to solve problems and even control emotions. They also experience increased change of personalities and in most cases they may get easily agitated or even see imaginary things as well as increased memory loss. The condition is said and reported to be prevalent among the elderly people but cannot be said to be part of normal aging. Registered nurses intervention in this condition will help in improving the symptoms and prevent the treatable conditions causing dementia such as depression and infection. Due to their vast knowledge and skills, specialist such as psychiatrist, geriatricians and neurologist may help in making early diagnosis through assessments. Diagnosis of dementia symptoms requires a combination of tests including taking patients health history, conducting physical examinations as well as conducting mental abilities tests as analyzed by Smith, Ali, & Quach, (2015).

These dementia patients in the home care facilities were identified to experience increased symptoms of nighttime motor behavioral characteristics, increased depression, anxiety and irritability as well as delusion symptoms. The rapid increase in the number of dementia patients prevalent among the aged populations has been attributed to factors such as the age, increased number of illiteracy and lack of practical social activities for the aged population (Veragiat, et al., 2017). These factors should, therefore, be recognized and appropriate activities established in order to give more focus on the individual and family care needs. Such complexity in the provision of health care to the aged populations has continued to increase the demand for more registered nurses due to their expertise and experience in handling health issues among the aged population in Australia. Mechanisms should be developed or adopted in the case of shortages in order to optimize the contributions of the registered nurses in functional outcomes of the aged residents in those Residential Aged Care Facilities (RAFCs) (Jackson et al., 2017).

Patient outcomes in the residential aged care facilities in Australia have been attributed to the positive nursing leadership styles employed by the registered nurses. Such a conclusion was based on the fact that the nurse leaders according to the Australian Nursing Council have a unique role of ensuring and promoting patient safety as they engage in the management of a great workforce and encounter a diverse range of interactions with patients. Such results show an increasing demand for services which can support the increased and growing patterns of frailty, dependence and complexity among the aged population in residential aged care facilities (Dwyer et al., 2017).


The registered nurses according to the Australian nursing council 2016 are responsible for a number of roles in health care provision and management as well (Ulrich, 2014). The planning and delivery of healthcare services among the aged groups living in Residential Aged care facilities are vested under the hands of the registered nurses. In his study, Ulrich (2014) provides that these nurses can play an influential management role in the residential aged care facilities by through a direct influence on the operational planning, coordination, delivery and monitoring of evidence-based health care practices. They also ensure that the services delivered are quality through blending skills together to treat chronic and acute illnesses as well as in the administration of person-centered nursing care of the residents.

Australian registered nurses are also held accountable and responsible for other important health care activities such as providing, managing and overseeing all the nursing care procedures by the non-registered nurses or other care assistants, in offering restorative care, responding to health care emergencies, offering palliative care in aid of pain management among the patients, management of medication practices toward the quality use of medicine guidelines as well as creating and participating in initiatives aimed at control and prevention of infections as observed by Rosenberg et al. (2016). It is also the role of the registered nurses to assess, plan, implement, monitor and evaluate nursing services to establish whether or not the services attain the quality threshold required and how effective are they in meeting the needs of the old aged residents in the care centers. Their professional experience has also placed them in a position to understand and work together with other health care personnel and health care service providers in coordinating, managing and delivering health care in the residential aged care facilities (RACFs) especially those with dementia (Mjorud et al., 2017).

The above findings can be used to deduce that the registered nurses role is very key in leading and overseeing safe and most effective care work, as they ensure there is adequate supervision, appropriate delegation of care to other staff such as the care assistants and maintenance and maintaining as well as retaining the overall accountability for provision of quality and coordinated health care (Street et al., 2015). Their study also provides that registered nurses can recognize and facilitate an earlier intervention and management when it comes to changing an individual health status. Such effect reduces risks of worsening the patient’s condition and the increased need for unplanned admissions to the health care facilities or to the emergency departments. It also provides that such an initiative not only help in maintaining quality health care to the healthcare recipients but also plays a major role in reducing the overall cost to the health system. According to the Australian College of nursing 2015a, the registered nurses should work together with other general practitioners, health professionals and service providers in the provision of quality care in the residential aged care facilities (RACFs).


The international and national research in the acute care sectors indicates a direct correlation between nurse to patient and the patient's mortality rate which provides that the nursing care teams with a higher proportion of registered nurses are associated with a decrease or reduced patient’s mortality. The main recommendation from the results of that report was that the nursing care teams in the residential aged care systems should have the appropriate number of registered nurses, enrolled nurses as well as the unlicensed health care workers for them to effectively meet the needs and demands of their patients. Such an effect is necessitated by the concerns of the Australian Council of Nurses, which requires that all the aged residents with complex needs in the residential aged care facilities together with their families are entitled to quality, safe and efficient evidence-based professional nursing and health care services. It further recommends that the Australian should recognize that the role played by the registered nurses and especially in the provision of health care for the aged populations in nursing homes cannot be substituted by any other category of health care worker (Baldwin, Chenoweth, & Dela Rama, 2015).

In order to optimize contributions of registered nurses in care homes, it is important to note that, care needs among the aged population as proposed by the Australian care quality commission, have greatly increased as residents become older and in most cases, they end their lives in the care homes. A major problem in the residential aged care facilities has been the shortage of registered nurses and hence bringing an unbalanced ratio of the care needed and the available number of registered nurses which negatively affects the quality of care needed and provided (Godden & Pollock, 2011). Such a concern necessitates the management to utilize the available number of registered nurses. Researchers, policy makers and service providers in the health sector proposed that in order to target effectively the resources of registered nurses it is important to understand the scope of duties performed by nurses which could be undertaken by care assistants as well as the non-registered nurses. Such duties can be performed by the health care assistants and even the non-registered nurses with the guidance, coordination, and supervision by the registered nurses. The Nursing and Midwifery Council 2016 also provides guidelines to delegation of nursing activities and specifically on the guidelines relating to administration of medicines. The Australian Nursing Council (2015b) also provides that, when looking or giving considerations as to who can deliver which element of health care among the aged populations and even in general health care for all people, it is important for the hospital or health care systems management to look beyond observable activity or task or health care need. There is a greater need of emphasis on the quality of knowledge, skills, and health workers expertise in undertaking their duties. If care in nursing homes is given under these grounds of expertise then it would be very easy to influence the outcomes of the residents.

Conclusion

It is also important to understand that, in order to optimize the registered nurses importance and their contribution, we also need to give an eye to the tasks and place more emphasis on the needs of the patients. It is also important to emphasis on the expertise which the registered nurses, the care assistants, and other essential health care personnel add to the nursing practice. Significant efforts should also be made in understanding how the health care practitioners can work together in provision of effective and quality health care. It will be inappropriate for the management or any healthcare provider to underestimate the complexity of the aging patients’ needs in care homes. Such a health needs necessitates high standards, expertise and nurses commitment from the home care staffs. Their contribution is considered very crucial in enhancing the well-being and functioning of patients as well as the conditions of living for the people in the residential aged care facilities (RACFs).

References

Baldwin, R., Chenoweth, L., & dela Rama, M. (2015). Residential Aged Care Policy in Australia - Are We Learning from Evidence?. Australian Journal Of Public Administration, 74(2), 128-141. doi:10.1111/1467-8500.12131.

Cik Yin, L., Beanland, C., Goeman, D., Johnson, A., Thorn, J., Koch, S., & ... Lee, C. Y. (2015). Evaluation of a support worker role, within a nurse delegation and supervision model, for provision of medicines support for older people living at home: the Workforce Innovation for Safe and Effective (WISE) Medicines Care study. BMC Health Services Research, 15(1), 1-11. doi:10.1186/s12913-015-1120.

CLINICAL UPDATE. ANMF'S AGED CARE STAFFING AND SKILL MIX PROJECT. (2017). Australian Nursing & Midwifery Journal, 24(9), 28-33.

Dwyer, T., Alison, A., Dolene, D., Darren, D., Craswell, A., Rossi, D., & Holzberger, D. (2017). Evaluation of an aged care nurse practitioner service: quality of care within a residential aged care facility hospital avoidance service. BMC Health Services Research, 171-11. doi:10.1186/s12913-017-1977-x.

Elliott, K. J., Annear, M. J., Bell, E. J., Palmer, A. J., & Robinson, A. L. (2015). Residents with mild cognitive decline and family members report health students 'enhance capacity of care' and bring 'a new breath of life' in two aged care facilities in Tasmania. Health Expectations, 18(6), 1927-1940. doi:10.1111/hex.12236.

Godden, S., & Pollock, A. M. (2011). The use of acute hospital services by elderly residents of nursing and residential care homes. Health & Social Care In The Community, 9(6), 367-374. doi:10.1046/j.1365-2524.2001.00314.x

Ives Erickson, J., Ditomassi, M., & Adams, J. M. (2012). Attending Registered Nurse: An Innovative Role to Manage Between the Spaces. Nursing Economic$, 30(5), 282-287.

Jackson, T. A., Gladman, J. F., Harwood, R. H., MacLullich, A. J., Sampson, E. L., Sheehan, B., & Davis, D. J. (2017). Challenges and opportunities in understanding dementia and delirium in the acute hospital. Plos Medicine, 14(3), 1-9. doi:10.1371/journal.pmed.1002247.

Mj?rud, M., Engedal, K., R?svik, J., & Kirkevold, M. (2017). Living with dementia in a nursing home, as described by persons with dementia: a phenomenological hermeneutic study. BMC Health Services Research, 171-9. doi:10.1186/s12913-017-2053-2.

Rosenberg, B. L., Kellar, J. A., Labno, A., Matheson, D. M., Ringel, M., VonAchen, P., & ... IIIMoses, H. (2016). Quantifying Geographic Variation in Health Care Outcomes in the United States before and after Risk-Adjustment. Plos ONE, 11(12), 1-21. doi:10.1371/journal.pone.0166762.

Salem, L., Crocker, A. G., Charette, Y., Seto, M. C., Nicholls, T. L., & C?t?, G. (2015). Supportive housing and forensic patient outcomes. Law And Human Behavior, 39(3), 311-320. doi:10.1037/lhb0000112.

Street, M., Ottmann, G., Johnstone, M., Considine, J., & Livingston, P. M. (2015). Advance care planning for older people in Australia presenting to the emergency department from the community or residential aged care facilities. Health & Social Care In The Community, 23(5), 513-522. doi:10.1111/hsc.12162.

Street, M., Ottmann, G., Johnstone, M., Considine, J., & Livingston, P. M. (2015). Advance care planning for older people in Australia presenting to the emergency department from the community or residential aged care facilities. Health & Social Care In The Community, 23(5), 513-522. doi:10.1111/hsc.12162.

Ulrich, B. (2014). The Responsibility and Accountability Of Being a Registered Nurse. Nephrology Nursing Journal, 41(3), 241-254.

Veragiat, S., Pensuksan, W. C., Suvanchot, K. S., Yooyen, C., Chetkhunthod, P., & Sarsanas, P. (2017). Prevalence of Dementia and Neuropsychiatric Symptoms among Elderly Patients Attending Outpatient Departments of Psychiatric Hospitals in Southern Thailand. Walailak Journal Of Science & Technology, 14(1), 43-49.

Smith, B. J., Ali, S., & Quach, H. (2015). The motivation and actions of Australians concerning brain health and dementia risk reduction. Health Promotion Journal Of Australia, 26(2), 115-121.

Hesseberg, K., Bentzen, H., Ranhoff, A. H., Engedal, K., & Bergland, A. (2016). Physical Fitness in Older People with Mild Cognitive Impairment and Dementia. Journal Of Aging & Physical Activity, 24(1), 92-100.

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