Care of the Older Person

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The aim of the following essay is to explore how nurses can ensure that older people are treated with respect and dignity whist being cared for in hospital or the community. The essay will seek to gain an understanding of the biopsychosocial influences associated with dignity which affect the older person. Age concern describe dignity to mean that everyone is treated and receives the care that meets their needs which enables them to live their life how they want (age concern 2008).

It is important that health care professionals are aware of the ethical and non-ethical values necessary for ach patient to feel his or her dignity is fully respected The ageing process effect a multidimensional process of physical, psychological, and social change.. Some dimensions of ageing grow and expand over time, while others decline. Reaction time, for example, may slow with age, while knowledge of world events and wisdom may expand. Research has shown that even late in life the potential exists for physical, mental, and social growth and development.

Ageing is an important part of all human societies reflecting the biological changes hat occur, but also reflecting cultural and societal conventions. Religion is often an important factor used by the elderly in coping with the demands of later life, and appears more often than other forms of coping later in life. Ageism can be described as the expression of negative attitudes and behaviours towards the aged (Bephage 2000). The population of the United Kingdom is ageing.

Over the last 25 years the percentage of the population aged 65 and over increased from 15 per cent in 1983 to 16 per cent in 2008, an increase of 1. 5 million people for his age group (office for national statistics 2009). Which such a large and growing population of older people within our society, which accounts for around two thirds of all hospital admissions (DoH 2000). We as nurses must understand ageism at all levels in order to tackle and reform the barriers, which have been created to discriminate and the bad practice that is seen today.

The issue of ageism affects the on largest growing groups of people within our society – the eldery. For many years the charity age concern has suggested that the issues of ge discrimination exited within our healthcare system, they finding were published in 1999 (age concern 1999) showing clear evidence that older people were being discriminated against within the healthcare system, simply because of they age and often not being treated with the dignity and respect they should be.

These findings were later to be confirmed in 2008 in the document “ quality not inequality”. Figures from help the aged show that 64% of older people think health and care staff don’t always treat older people with respect for their dignity (help the aged 010). In response to this evidence “the NHS plan” (DoH 2000) identified a shortfall of national standards as a main factor towards the failing of the health service towards not delivering appropriate care for all.

In response to this and other evidence the department of health launched in 2001 the national service framework (NSF) for older people was introduced the aims of which was to help older people benfit from health and social care interventions that will help them reduce the period of disability and to increase the years of active healthy life. It stated that all care provided in hospital should respect the older person’s dignity. The underpinning principle of the NSF was person-centred care central to this is respect for the patients values and how they understand and perceive what is happening.

It included plans to eradicate age discrimination and to support person-centred care with newly integrated services. The framwork offers 8 standards all of which are evidence based which are ; Rooting out discrimination this makes clear that age limit should not be placed on services and that all services should be delivered acording to clinical need. Respecting the individual; Intermediate care; Providing evidence-based specialist care and Promoting an active, healthy life. The NSF makes it clear that in the past older people and their carers were not always treated with respect or with dignity.

It than goes on to suggest that delivering good care for older people in hospital requires that staff have the appropriate skills and experience. This care should be underpinned by fundamental principles that promote dignity (Webster 2004). Within the UK the nursing code of professional conduct states that egistered nurses must respect they patients and promote and protect the interests and dignity of patients at all times this emphasises the importance of respecting the patient as an individual, (Nursing and Midwifery Council (NMC) 2008).

The care of the older patient involves special expertise for many reasons such as physiological ageing and the effects of medication may alter the disease presentation; pre-existing conditions may make self-care more difficult and the incidence of depression and dementia more common; and arranging social support for successful discharge requires complex skills. While a patient may have been admitted with a physical problem, emotional issues are often also present, depression is common in older people which is not always identified.

Despite many older people experiencing depressive feelings about only one in six feels so depressed that others notice and only one in 30 people are diagnosed by a doctor as having a ‘depressive illness (Lawson 2006). Inadequate nursing care is not exclusive to the elderly, but it is often nurses who work with older patients who appear to be continually coming under fire, particularly around issues related to patient dignity(Lomas 2009). Bedrail are commonly used in health care settings, . The most common reason given by staff for using bedrail use is falls prevention (NPSA, 2007).

Some papers on bedrails have automatically categorised them as a form of physical restraint, describing their use as ‘unethical’(Healey 2009). Bedrails used to prevent an accidental fall from bed would be unlikely to be considered as restraint using the definitions,from the RCN 2007 which suggested an ethics-based definition of restraint: ‘the intentional restriction of a person’s voluntary movement or behaviour’ or ‘stopping them doing something they appear to want to do’. hile using bedrails to keep a patient in bed against their will would be. estraint. Some however would say that Bedrails… deprive older patients of their dignity and autonomy’ (Hanger et al, 1999). There were two categories of staff behaviour which could threaten or promote dignity: actions by staff relating to privacy, and staff communication (Baillie 2007). Baillie (2007) found that Most staff were consistently vigilant about providing privacy however she found that staff wounld often breach patients privacy by walking in behind closed urtains without any warning.

Views that have been expressed by patients are that nursing staff do tried hard to maintain privacy primarily by drawing curtains, by asking before entering curtains and by taking patients to private areas (such as bathrooms) if at all possible ( Webster 2009). This has been observered on many practical placement by the author. Curtains are considered important in the promotion of dignity, but offer limited privacy. It is suggested that it is more than the actual pulling of curtains, which made patients, feel their privacy is promoted.

Rather that it is the nurse behaviour is crucial in maintaining dignity. Patients appreciated that nurses tried to reassure patients to promote privacy and dignity. However, nurses did not always empathise with patients during their experiences (Webster 2009). The Dignity in Care survey (Department of Health 2006) invited views via their website from health care professionals, patients, carers and members of the public. These views also highlighted the importance of communication and individualised care as important concepts in the promotion of dignity.

Following the launch of the NSF, the link between autonomy, dignity and independence is being promoted thought the development of the intermediate care services. Intermediate care is a range of services targeted at patients who would otherwise face an unnecessarily prolonged hospital stays, inappropriate admission to acute inpatient care, long-term residential care, or continuing NHS inpatient care To have respect for a person we must ensure they are fully aware of all the choices they have, fully understand what is being said to them.

We ust show the principles of privacy, consent, confidentially and show non-discrimination. If we have respect for people we must respect their wishes and any decisions they make about themselves and their health- care choices. To show respect for individuality communication has to be closely related to care given. It is not simply enough that communication runs parallel to practice. Nurses needs to know how to ‘ say the words’ that give meaning and dignity to physical care. Patients need to feel that they have an equal and influential role in health care.

Dignity can be respected by a feeling f some degree of control over a situation by offering choice. The nurse needs to give a balance between honesty and reassurance. The ability to maintain privacy is virtually impossible on some type of wards were patients can be in large open bays, on wards were ward rounds take place up to twice a day. Curtains can be close so to show respect but other patients nearby can still hear the conservation taking place between staff and patient (Baillie 2007). This lack of privacy does not help to protect a patients right to confidentiality (Human right act 1998).

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