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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Serie: Wiley Series on Cognitive Dynamic Systems
- Sprache: Englisch
As the environment of care continues to evolve to promote person-centredness, dignity, health, and wellbeing, for nurses working with older people, this can be challenging. Nursing Older People at a Glance is a timely publication which provides an overview of key concepts that nurses need to know in order to care for older people in a wide range of settings.
Divided into six sections, it explores a range of themes such as person-centred care, health and wellbeing, health promotion, and the complexity of older people's care, encompassing mental wellbeing, diverse communities and learning disability.
With a strong focus on dignity in care throughout, Nursing Older People at a Glance will readily equip undergraduate and post-qualification nurses with the knowledge and skills required to care for older people in a competent and compassionate manner.
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Seitenzahl: 242
Veröffentlichungsjahr: 2018
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This title is also available as an e-book.For more details, please seewww.wiley.com/buy/9781119043867
Nursing Older People at a Glance
Edited by
Josie Tetley
Nigel Cox
Kirsten Jack
Gary Witham
all at The Faculty of Health, Psychology and Social Care Manchester Metropolitan University Manchester, UK
Series Editor: Ian Peate OBE, FRCN
This edition first published 2018 © 2018 John Wiley & Sons, Ltd.
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The right of Josie Tetley, Nigel Cox, Kirsten Jack, Gary Witham to be identified as the authors of the editorial material in this work has been asserted in accordance with law.
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Library of Congress Cataloging-in-Publication Data are available
ISBN: 9781119043867
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Cover design by Wiley
Contents
Contributors
Introduction
Our aims for this book
How the book is organised
Dignity as a core concept for older people’s care
References
Part 1 Person-centred care in practice
1 Promoting person-centred care
References
2 Capacity and consent
Consent
Factors influencing informed consent
References
3 Communication
Communicating with older people
Summary
References
4 Compassion
Model of compassionate care
What is compassion from an older person’s perspective?
Developing compassionate environments
Supporting compassionate care
References
Part 2 Quality of life in practice
5 Quality of life
What is quality of life (QOL)?
Quality of life and the individual
Having choices
Social activities
Safety
Physical health
Implications for practice – how might we work towards quality of life?
Supporting staff to support older people’s needs
Conclusion
References
6 Nutrition and hydration
Why is nutrition and hydration a concern in older people?
How can effective hydration and nutrition be promoted?
References
7 Hearing and vision
The ear and hearing
(Figure 7.1)
The ear and balance
Age-related changes in hearing
The eye and vision
(Figure 7.2)
Ageing and vision
References
8 Pain
References
9 Sleep
How much is enough sleep?
References
10 Continence
Continence problems
Continence care checklist – options and actions
References
11 End of life care
Communication
Health promotion at end of life care
References
12 Sexual health and well-being
Identifying the older person’s sexual health needs
Sexual health dysfunction and comorbidity
Promoting sexual health in older people: the role of the nurse
References
13 Carers
Carer information needs
Carer involvement in formalised healthcare
Hidden carers
Partners in care
References
Useful contacts and organisations
Part 3 Promoting health in practice
14 Health promotion
Nursing and health promotion in older people
Making every contact count
The future for health promotion in older people
References
15 Falls and falls prevention in older people
Description of falling
Types of falls
Risk factors for falls
Preventions of falls
Education and information about preventing falls
References
16 Medication management
Medicines management
Patients and carers
Summary
Further reading
17 Polypharmacy
Polypharmacy in older people
Pharmacokinetics
Pharmacodynamics
Prevention of polypharmacy problems
Benefits of reducing polypharmacy
Summary
Further reading
18 Skin care
Looking after an older person’s skin
The function and structure of skin
Ageing skin
Older people and skin care
References
19 Pressure area care
Assessing and preventing pressure ulcers in older people
Frailty in older people and the associated risk of pressure area tissue damage
Harm caused due to pressure damage to localised tissue
References
20 Infection control
The chain of infection
Ways of reducing the risk of infection in older people
References
21 Older people and the arts
Background
What are arts-based approaches?
Conclusion
References
22 Physical activity in older age
Exercise for health
What types of exercise?
References
Part 4 Complex care in practice
23 Mortality and morbidity: focus on frailty
The older people get, the more likely they are to accumulate health problems
Interventions to support frail older people
References
24 Long-term conditions and comorbidities
What are long-term conditions?
The role of the nurse supporting people living with long-term conditions and comorbidities
References
25 Good practice in dementia care
Introduction
Types of dementia
Diagnosis
Essentials of best practice: treatment and management
Ongoing support
Conclusion
References
26 Caring for the older person with delirium
Experiencing delirium
The ABC of behaviours
Recognising delirium
References
Further learning resources
27 Severe and enduring mental health problems in older life
Severe depression
Schizophrenia
Approach to care intervention
References
28 Recognising dying
Advanced care planning
Preferred place of care
References
29 Grief, loss and bereavement
Society and loss
Theories of loss, grief and bereavement
Factors affecting grief
Role of the nurse
Nursing skills when supporting bereaved individuals
References
30 Safeguarding
Ageing population
Recognising potential vulnerability and creating a protective environment
Recognising abuse and taking action
References
31 Spiritual beliefs and religious practices
References
Part 5 Equality and diversity in practice
32 Promoting dignified care for diverse communities
References
33 Supporting good mental health in older people
Depression
Anxiety and associated disorders
References
Further resources
34 Ageing without children
Who is childless?
What do older childless people want?
References
35 Lesbian, gay, bisexual and transgendered older people
Person-centred care
Battling discrimination
Health promotion/sex and sexuality
Conclusions
References
36 Older people with learning disabilities
Implications
Conclusions
References
37 Substance misuse (drugs and alcohol)
Isn’t substance misuse a problem for everybody? What’s special about older people?
What do we mean by ‘substance misuse’ in older populations?
How are older people at risk from substance misuse?
What can we do to address substance misuse in older people?
References
Part 6 Environments of care and practice
38 Autonomy and independence
Respecting autonomy, independence and choice with the needs of older carers
References
39 Transitions in care
Transition into acute care
Support in acute care environments
Conclusion
References
40 Coordinating care
Complex needs of older people under our care
Coordinating acute hospital care and discharge planning
(Figure 40.1)
What is the nursing role within the MDT when coordinating the care of older people?
Conclusion
References
41 Care at home
Introduction
Integrated healthcare
Nursing in the home
Home health assessments
Carer support
References
42 Social isolation and loneliness
References
43 Communal living
Almshouses
Social housing for older people
Sheltered housing
Retirement villages
Co-housing
Conclusion
References
44 Assistive technologies
The role of assistive technology to support older people
Benefits of assistive technology and telecare
Accessing equipment
Supporting equipment use
References
45 Older prisoners
Health needs
The environment
The prison nurse’s role
Assessing the needs of older prisoners
Older prisoners in the community
The community and hospital nurses’ role
References
Index
EULA
Guide
Cover
Table of Contents
Introduction
Pages
vii
viii
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105
Contributors
Razia Aubdool, Chapters 16 and 17
Canan Birimoğlu, Chapter 15
Louise Bowden, Chapters 16 and 17
Jacqueline M. Cash, Chapter 10
Michelle Croston, Chapter 3
Nigel Cox, Chapters 24 and 38
Donna Davenport, Chapter 25
Jan Dewing, Chapter 26
Garry Diack, Chapter 36
Fiona Duncan, Chapter 8
Chris Ellis, Chapter 9
Marilyn Fitzpatrick, Chapter 41
David Garbutt, Chapter 29
Linda Garbutt, Chapter 2
Robin Hadley, Chapter 34
Carol Haigh, Chapter 8
Caroline Holland, Chapter 43
Maxine Holt, Chapter 14
Lindesay Irvine, Chapters 18, 20 and 39
Kirsten Jack, Chapters 4, 21, 38 and 45
Emma-Reetta Koivunen, Chapters 42 and 44
Janet Marsden, Chapter 7
Jamie McPhee, Chapter 22
Julie Messenger, Chapter 6
Eula Miller, Chapters 27 and 31
Duncan Mitchell, Chapter 36
Gayatri Nambiar-Greenwood, Chapters 1 and 32
Stewart Rickels, Chapters 19 and 40
Caroline Ridley, Chapter 30
Stuart Roberts, Chapter 35
Carol Rushton, Chapter 25
Clare Street, Chapter 5
Stuart Taylor, Introduction
Josie Tetley, Chapters 21, 24, 42 and 45
Lucy Webb, Chapter 37
Danita Wilmott, Chapter 12
Gary Witham, Chapters 11, 13, 23, 28 and 33
Introduction
Our aims for this book
This book is primarily aimed at undergraduate and post-qualification nurses who care for older people in a range of care settings including hospital, community, residential and other health or social care settings. The editors and contributing authors believe that this book will also be of value to a wide range of practitioners working in a nursing or a nurse-related capacity, for instance pre-registration nurses, healthcare assistants, associate practitioners, registered nurses working in both the NHS and independent care home sectors, and those returning to a career in nursing.
Nurses are under increasing pressure to demonstrate that the care they deliver is supported by best evidence, compassionate and person-centred. For nurses working with older people this can be challenging, as people’s needs in later life are often complex and diverse. This book therefore provides an accessible overview of key concepts that can help nurses understand how care in practice can be more person-centred, while also promoting dignity, health and well-being.
How the book is organised
The book is divided into six parts. Part 1 introduces concepts central to dignified and compassionate person-centred care. Part 2 explores health and well-being, including essential aspects of living such as sleep, the senses and nutrition. Part 3 focuses upon health promotion, and incorporates a diverse range of topics including physical activity and the arts. Parts 4 and 5 address complexity and diversity in older people’s care, including topics such as mental well-being, diverse communities and learning disability. Part 6 concludes the book, and illustrates how environments of care impact on practice. Autonomy and independence are central principles, and the role of assistive technologies and the challenges of working with older people in a diverse range of contexts are considered.
Dignity as a core concept for older people’s care
Dignity in care work focuses on the value of every person as an individual. It means respecting others’ views, choices and decisions, not making assumptions about how people want to be treated and working with care and compassion
Skills for Care, 2017
The concept of dignity shapes all of the chapters in this book. However, making dignity in care a reality also means that nurses and other healthcare professionals need to be able to understand what this means in the context of people, places and processes in multiple and complex ways (Figure 0.1). The importance of dignity in care is also underpinned by the Nursing and Midwifery Council (NMC) code of conduct (Figure 0.2) which, at the time of writing, states that nurses must:
Figure 0.2The Nursing Midwifery Council (NMC) code of conduct.
Source: Nursing & Midwifery Council (2015).
When considering dignity-related matters for patients we tend to think of some of the more personal situations such as receiving assistance with bathing, dressing or toileting, but recommendations from Age UK (2013) serve to remind nurses of the need to think widely and creatively about older people’s care. From admission to hospital or any point of care, it is important to develop a professional but caring relationship that takes account of the wider and more holistic needs of older people and their carers. This book provides some practical guidance about how these needs can be met in ways that uphold dignity in care. However, it is also important to remember that understanding and appreciating individual values, beliefs and practices is not easy, and key areas related to dignity need to be considered from the outset of the patient journey (Royal College of Nursing, 2008, 2017); again, key chapters in this book provide guidance about good practice in nursing on this.
The editors and authors who have contributed to the development of this book recognise that there are no easy solutions to providing individualised and dignified care for older people. By providing a range of short, but succinct evidence-based chapters, this book presents guidance about key concepts that can support dignity in care in the context of the key difficulties and challenges that nurses encounter in practice.
Josie Tetley
Nigel Cox
Kirsten Jack
Gary Witham
Stuart Taylor
References
Age UK (2103) Delivering Dignity: Securing dignity in care for older people in hospitals and care homes. London: Age UK. Available at:
http://www.ageuk.org.uk/Global/Delivering%20Dignity%20Report.pdf?dtrk=true
(accessed 27 September 2017).
Nursing and Midwifery Council (2015) The Code. Professional standards of practice and behaviour for nurses and midwives. London: NMC. Available at:
https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf
(accessed 27 September 2017).
Royal College of Nursing (2008) Dignity at the heart of everything we do: Defending Dignity – Challenges and opportunities for nursing. London: Royal College of Nursing. Available at:
http://www.dignityincare.org.uk/_assets/RCN_Digntiy_at_the_heart_of_everything_we_do.pdf
(accessed 27 September 2017).
Royal College of Nursing (2017) Preserving people’s dignity. First steps for health care assistants. London: Royal College of Nursing. Available at:
http://rcnhca.org.uk/equality-diversity-and-rights/preserving-peoples-dignity/
(accessed 27 September 2017).
Skills for Care (2017) Dignity in care work. Leeds/London: Skills for Care. Available at:
http://www.skillsforcare.org.uk/Topics/Dignity/Dignity.aspx
(accessed 27 September 2017).
Part 1Person-centred care in practice
Chapters
1
Promoting person-centred care
2
Capacity and consent
3
Communication
4
Compassion
1Promoting person-centred care
To provide person-centred care (PCC) for any patient or client means that they are included in decision making about their care. PCC in the older person cannot be successful unless the ethos of the wider MDT is one of a shared partnership with each other and the patient.
In order for PCC to be effective for all concerned, nurses involved in caring for the older person need to be aware of a number of factors. This involves not only looking at the needs of the patient and considering their definition of satisfaction, but also, fundamentally, staff considering their understanding of older people and PCC itself.
It is important that nurses have an awareness of their own attitudes regarding older people. The media often portrays older people as being dependant on others and it is inevitable that this will have an unconscious effect on our attitude (Koskinen et al., 2014) and affect our interpersonal skills that are fundamental to effective PCC. In not acknowledging the diversity of the older population, in terms of their ability and capacity, we are reducing them to a homogeneous group incapable of being asked about or making decisions of their own, for themselves (Phelan, 2011). By becoming aware of culturally influenced attitudes about the older person and how these outlooks are mirrored in the ways older people are observed, treated and cared for in society, the nurse and the MDT can better understand the premise from which to provide high-quality PCC.
McCormack and McCance (2010) developed a ‘Person-Centred Nursing Framework’ and this framework has four constructs that are fundamental to delivering PCC in the older person effectively. They are:
Prerequisites
The care environment
Person-centred processes
Outcomes.
These constructs are presented in Figure 1.1 with examples of the questions the nurse might consider when delivering PCC in the older person.
Having taken into consideration the constructs above as fundamental to delivering effective PCC, the nurse, due to cultural differences, also needs to appreciate those intrinsic factors that will affect what can be called the ‘intergenerational conversation’ that occurs between the patient and nurse.
Bochner (2013) asserted that intersubjective values such as power, hierarchy, status, subordination and perceptions of equality affect intergenerational conversation more than previously imagined. Bochner emphasises that any contact between professional and patient can affect the communication and behaviour of both parties due to the interaction being a heavily differing value-oriented encounter. Intergenerational communication does not just include the entire range of communication skills across boundaries of age groups but also takes into account gender and cultural factors.
An awareness of these factors is important if the patient is going to be comfortable to express their needs and for the nurse–patient relationship to be mutually beneficial. It is important for the nurse to be aware of the intergenerational implications of both verbal and non-verbal aspects of conversing with those who are of a different age group, and perhaps, feeling vulnerable in a care setting. As mentioned at the beginning of this chapter, it is essential that the nurse be aware of his or her own socialised prejudices or prejudgements that may affect their interpersonal behaviour. Both these traits affect the tone and values of conversation that follows, in which the patient comes to recognise the identity that the nurse is now giving them, be it positively or negatively (Samovar et al., 2013).
The notion of PCC is complex and multi-dimensional. For it to be successful, the MDT needs to work at sustaining a reflective and honest planned culture change, which is necessary to embed the values of PCC of older people in daily practices. Good nurse leadership and the care environment are key influencing factors on the way that person-centredness is experienced by patients, their families and the MDT. For PCC to be experienced in a consistent and continuous way by these patients, the culture of practice has to support a compassionate, humanistic and creative way of practising, that enables care teams to flourish or achieve patient satisfaction. In adopting this change in culture, ultimately, the nurse is working towards promoting those notions around self-determination and purposeful living, often taken for granted when we are young.
References
Bochner, S. (2013)
Cultures in Contact: Studies in Cross-Cultural Interaction
. Oxford: Pergamon Press.
Koskinen, S., Salminen, L. and Leino-Kilpi, H. (2014) Media portrayal of older people as illustrated in Finnish newspapers.
International Journal of Qualitative Studies on Health and Well-being
. doi: 10.3402/qhw.v9.25304.
McCormack, B. and McCance, T. (2010)
Person-Centred Nursing: Theory, Models and Methods
. Oxford: Blackwell Publishing.
Phelan, A. (2011) Socially constructing older people: Examining discourses which can shape nurses’ understanding and practice.
Journal of Advanced Nursing
67: 893–903.
Samovar, L.A., Porter, R.E. and McDaniel, E.R. (2013)
Intercultural Communication: A Reader
, 11th edn. London: Thompson Learning.
2Capacity and consent
Consent is one of the cornerstones of good healthcare practice. It enables patients to exercise their autonomy, their choices, their free will and self-determination. Patients should no longer feel passive recipients of care, rather consumers of a health service where equity, respect and mutuality are recognised (Department of Health, 2012). The promotion of consent allows practitioners to develop therapeutic relationships with patients and service users, promoting reciprocity, equality and trust, all of which are fundamental to the core values within the National Health Service Constitution (Department of Health, 2015). Thus, all individuals receiving care, where possible, must give their permission for that care to be delivered.
Consent
Conceptually, consent can be divided into two distinct categories: informed and implied consent (Figure 2.1).
The Nursing and Midwifery Council (2015) and the General Medical Council (2008) clearly articulate that any decision made by patients surrounding any aspect of their care, should be informed in nature. This requires that patients are fully aware of the reasons for their treatment, any side effects that may occur and the risk of any potential harm that may be suffered as a result of this care. Having considered all of this information, the benefits, risks and burdens, patients have the right to agree to or refuse treatment. Sometimes the refusal of treatment may be seen as an unwise decision, which is detrimental to the patient’s health and against the advice of the healthcare professionals; this refusal must still be respected in the competent patient (Nursing and Midwifery Council, 2015).
Informed consent needs to be integrated into all aspects of nursing care delivery, not just major surgery or medical procedures. This means that everything from assisting a patient with personal hygiene needs, to the administration of medication or the delivery of nursing procedures must be fully explained to the patient, who then agrees to the provision of that care. However, studies have suggested that informed consent prior to the delivery of nursing care is ‘under-developed’, with many nurses relying on implied consent and failing to respect refusal of treatment prior to the delivery of nursing procedures (Cole, 2012).
Within the context of healthcare the Professional Regulatory Bodies (General Medical Council, 2008; Nursing and Midwifery Council, 2015), statute (Mental Capacity Act 2005, Human Rights Act 1998, Criminal Justice Act 1988) and ethical practice (Nursing and Midwifery Council, 2015) drive the need for informed consent. Failure to obtain informed consent has multiple consequences; for patients their human rights are violated and the acceptable standard of care expected is compromised. For the practitioners involved, lack of adherence may lead to professional misconduct hearings, employment tribunal or liability in negligence (General Medical Council, 2008; Nursing and Midwifery Council, 2015). Furthermore, if treatment or care is provided without the patient’s informed consent, civil or criminal proceedings may be instigated due to charges of battery (trespass to the person) or assault (where malicious criminal intent is proven).
Factors influencing informed consent
There are many factors that may impact upon the ability to gain informed consent from a patient, particularly if they are older. There is a need to recognise and acknowledge the diversity of the older patient population in relation to information giving and consent, thus tailoring information based around patients’ individualised needs. Language, sensory impairment, literacy and cognition are all features that could influence comprehension. Nurses must take all practicable actions to facilitate understanding where possible. Therefore, providing adequate time, a quiet environment, written information in a suitable font size and the involvement of family and friends (with consent) so more people can retain the information are practical ways to facilitate this.
The Mental Capacity Act (2005)
The Mental Capacity Act (2005) (MCA) provides clear legal parameters for practitioners to promote autonomy, with the assumption that everyone (over the age of 16) has the capacity to make decisions surrounding their care unless evidence suggests otherwise (Box 2.1).
The principles given in Box 2.1 reduce the potential for paternalism and prejudice, clearly highlighting that assumptions regarding capacity should not be made purely on the basis of age, medical condition or diagnosis. Based upon this framework, it is important to note that some patients may be able to provide informed consent and refusal regarding certain aspects of their care, such as whether they wish to receive personal care; however, they may not be deemed competent to make more complex healthcare decisions.
If an individual is assessed as lacking capacity to make a decision about their care autonomously, those making a decision on their behalf must adopt the principle of ‘best interest’, according to the Mental Capacity Act (2005). Healthcare staff should therefore make every effort to understand what the patient would have wanted were they able to autonomously make the decision themselves. This requires the holistic assessment and understanding of the unique nature of that patient, and may require discussions with family members to establish, if not documented within an advanced decision, the wants and wishes of the patient when they had capacity.
A key issue, which must be addressed, is that family members are not able to consent on behalf of their loved one, unless they have been nominated by a Lasting Power of Attorney (LPA). Under the Mental Capacity Act, the attorney is an individual that the patient nominates to make choices about their health, welfare and the management of property, when capacity is lost. There is an official process to be followed in adopting this role and the LPA must be registered with the Office of Public Guardian.
Safeguarding the rights of those who have lost capacity is inherent within the Mental Capacity Act. Major decisions surrounding the deprivation of liberties, the instigation or withdrawal of serious medical treatment, long-term continuing care and rehousing will often require liaison with local authorities, Independent Mental Capacity Advocates (IMCAs) or court-appointed Deputies. The Court of Protection will hear cases surrounding serious medical treatment decisions and will try to resolve disputes surrounding differences of opinion between the patient’s carer and healthcare workers.
In order for consent to be valid, it must be made voluntarily, without coercion, and must be provided by a mentally competent patient (see Figure 2.2).
Lack of capacity may be transient or due to a long-term health breakdown such as brain injury, mental illness, levels of consciousness, phobias, confusion, delirium, intoxication and intellectual disability.
