GLS101 Promoting Excellence Program
Question:
Evaluate evidence-base for the assessment, planning and evaluation of holistic and compassionate care for older adults and their families.
Evaluate the concept of healthy ageing and the national and international strategies for health promotion.
Critically explore the effectiveness of nursing theories and approaches to working with older people who have complex needs.
The format of the assessment is an essay with the inclusion of a plan of care related to a relevant and agreed case study. The assessment is designed to allow you to meet the four learning outcomes above.
Answer:
Introduction
In the context of the rapid aging population, Singapore is anticipating a rise of the morbidity, disability and dependency that driven by physical fragility. According to Chan et al., (2013), Singapore is facing one of the toughest economic and social challenges since it is independent in the form of rapidly aging population. National survey of senior citizen (NSSC) has been conducted a periodic survey for keeping track of the aged population and health status of them. According to that survey report, in 2009 a total of 10000 households at least one individual of 55 years or older were found where 15% of the households were ineligible for older people focusing on the personal characteristics of the survey, in Singapore, amongst those 55 years had above, 47% are male where as 53% of older population are female (Ng et al., 2013). A country based cross sectional study suggested that while Singapore is a highly developed country by worldwide standards, the older population was suffering from certain health crisis that increases the burden of the disease had affected the economic status. A study by, suggested that a considerate number of older individual in Singapore suffered from health crisis such as major depressive disorder, anxiety, cerebrovascular accidents and urinary incontinence. Depression impacts older population different than younger population since the depression generally observed in older people in Singapore often associated with medical illness and disability which last longer. Depression often observed in elderly women if they lose their independence of working due to physical disability or if the family member lives away or feel abundant which further leads to anxiety. In older adults, cerebrovascular accidents often caused by blocked artery due to series health disease such or due to sudden fall. In Singapore, prevalence of cerebrovascular accidents often estimated at 3.65% for adults above 50 years which posing challenges to the health care system (Chandran et al., 2013). Urinary incontinence is a normal part of aging which is more common in women over 50 years and affects one woman out of three women in Singapore. Therefore, in order to manage these health issues for physical and mental well-being of older population, excellent nursing care is required which would provide them a sense of security, comfort and enhance quality of life. The aim of the paper is to address health care theories such as aging theory, nursing theory and health improvement theory in order provide excellent nursing care to the elderly population of the Singapore. Therefore, in the first part of the paper will illustrate a case study by applying the nursing theories for effective nursing care. The second part of the paper will illustrate a care plan for the elderly patient with the help of senses frame work.
Part 1
Case study
Ms. Maria is an 80 year old woman who is a subacute rehabilitation patient. She was referred for a psychological evaluation as she had been suffering from anxiety and depression. Few days back the patient Maria had suffered from right frontal lobe cerebrovascular accident (CVA) due to which she developed a left-sided hemiparesis. One of her greatest health concern was that her urinary incontinence along with the subsequent changes occurred in privacy. The reports showed that the patient has never been married therefore had no children. She was a successful and independent women however this changed after the occurrence of CVA. She worked for the welfare of the low-income children as well as their families. She had been involved in registered home health nursing. The patient reported of worsening frequencies of urination along with incidences of recurrent urinary tract infections (UTIs). She reported that this led to the decrease in the quality of her life which had taken place about 10 years ago. As a result of this, over the years she was forced to focus on this symptom which had affected her personal and professional life and this made her withdraw herself from several activities. This had made her more conscious of her disability. This often made her feel abandoned increasing her stress and her concerns regarding urinary incontinence which in turn increased her requests for help.
Due to the increasing number of senior citizens who are entering their silver years, the government of Singapore is placing some special schemes in order to bring out social support to help them get through their retirement years. One of this scheme is the Medisave which is a national medical savings scheme. This helps the people to put aside a part of their income into this medisave account, which in future will help them to pay for their personal and immediate family’s hospitalizations costs and certain outpatient expenses in any hospital in Singapore. Another scheme is the Enhancement for Active Seniors (EASE), which is a part of the Home Improvement Programme (HIP) (Ng et al., 2015). This allows the patients to enjoy subsidies from the government. Another is the ComCare Long Term Assistance which is also known as Public Assistance along with Silver Support Scheme according to which the government gives payout of $300 – $750 to the 20% of seniors having low incomes throughout their life and little or no such support from the family. Several other schemes of the government includes the Pioneer Generation Package (PGP), the Lease Buyback Scheme (LBS) and finally the Senior Citizen Concession Card. According to this, the senior citizens are able to enjoy lower fares on the trains and buses after the launch of the Off-Peak Pass (OPP) (Feng et al., 2014).
Additionally the Singapore’s Ministry of Health (MOH) had established an outline for an action plan with regards to successful ageing which is was involved of ten areas of focus. These ten priorities included senior volunteerism, employability, health and wellness, lifelong learning social engagement and inclusions, housing, transport, aged care services, public places, and research on ageing (Ramjaun et al., 2013). It was also seen from the research reports that the government of Singapore thrived to put the responsibility for the older population’s health and wellbeing on the senior individuals themselves or their families.
The theories like the ageing theory, nursing theory and others like the health care intervention theory which helps to bring the explanations in the form of data in order provide guidelines for action. The theory of ageing comprises of the biologic, the physiologic and the social theories. An important purpose of theories is to challenge the practise in order to create approaches that are new and will help to remodel the structures of care that are to be provided to the older adults. Therefore it is important to implement the theories of nursing for the care of older people having the aim to support them throughout their process of ageing (Vaingankar et al., 2016).
The ageing theory
The ageing theory comprises of several developmental theories including the Maslow’s hierarchy of human needs through which the people or the patient her might strives towards the aspect of self-actualization through various stages. This in turn will help the patient Marie to realise the importance of any task for herself which will not necessarily be age-specific in nature. The next is the Jung’s theory of individualism that includes the stages of old age while turning oneself inward in order to reflect for answers. The inner direction for the patient might mean that the factors which are external for health are most of the time less important to patient; motivation may have to come from within. Another is the course of human life, which describes that old age is the time for rest as well as to review one’s life (Sitar t al., 2013). As a part of this theory, the patient might view old age as a kind of reward where one would expect commensurate treatment. Finally there is an Erikson’s eight stages of life, where there must be ego resolved for a crisis in each of the stage. In old age it would also involve a looking back at life in addition to the acceptance death where there is ego integrity versus despair. According to this in terms of the patient, the anxiety regarding the issue like death might be of utter importance. Additionally the importance of the exacerbated due to the unknown that accompanies diagnostic testing. The patient who is an older adult and has successfully resolved the crisis who will be comfortable while speaking about death additionally with the technologist should not negate or ignore such discussions (Chan et al., 2013).
The nursing theory
The nursing aims to predict as well as describe the phenomenon and also explain the process of nursing. According to the nursing theory, the older people such as the patient here Maria must be offered with patient- centred nursing. Nursing theory is able to provide the principles that help in guiding the practice as well as person-centered care (PCC) (Orr, Elliott & Barbour, 2014). This is often regarded as a venerable nursing theory mainly at times when it comes to senior care. The patient centred care is involved in focusing on knowing of the person in addition to the other factors like respecting the personhood of then patient. Provision of comfort to the patient apart from maintenance of a supportive physical and organisational environment is important part of the patient centred care. Additionally the approaches of the person-centered care towards the senior care are able to create the conditions which enable the older people to participate in meaningful lives, and potentially improve their well-being (Chandran et al., 2013). Through the use of nursing theory the patient Maria can develop a mutual relationship with the nurse or her care givers which will help her to reduce her feelings of abandonment. Additionally, the person centred care also demands competence in order positive health outcomes, as well as increased confidence in the ability of the family for providing care which would also indicate that the person centred care is taking place.
The senses framework
In terms of the care of older people like the one mentioned in the care study, the major emphasis should be on the service development which will help in reflecting the user’s wishes and of their carers rather than that of the perceptions of the care providers. However it has been seen that it is quite important to consider what counts for older people and their family carers, therefore this a good quality of believe and care should be provided so that the patients as well as the carers can be satisfied. According to (Orr, Elliott & Barbour, 2014) due to the lack of a therapeutic rationale in regards of the work in long-term care settings in terms of the older people, there was an identification of six Senses that was believed to be able to show a clearer direction for staff as well as improve the care older people that they received. Sense was a term that was selected deliberately which is able to reflect the perceptual nature and subjective of important determinants of care both for older people and staff. The six senses involves the sense of security, the sense of continuity, the sense of belonging, the sense of purpose, the sense of fulfilment and finally the sense of significance. According to the sense of security, the attention is essential for the older people in terms of the physiological and psychological needs and in order to feel safe from any kind of threat, pain, harm and discomfort as well as to feel free from these. According to the sense of continuity there is recognition along with value of personal biography (Mimi & Ho, 2013). In terms of sense of belonging the opportunities are able to form relationships that are meaningful in order to be a part of the community. The sense of purpose allows them to engage in n purposeful activity. Additionally the sense of fulfilment and the sense of significance allows the person to meet meaningful goals and to feel valued and recognises as a person having worth (Van den Block et al., 2015).
Part 2:
In order to complete the needs of the elderly patients and help them to get a superior quality life senses frame work was proposed. For the sense of framework, it sees beyond the aged individual’s medical needs and considers the other needs of the individuals so that holistic approach is employed. Senses frameworks requires care environments where patients enjoys the sense such as sense of security, sense of belongings , sense of continuity ,sense of purpose, sense of achievement and sense of significance. Refereeing to the case study of above discussed, Maria, an 80-year-old women who is a sub-acute rehabilitation patient. She was referred to the psychological evaluation due to the depression. She experienced cerebrovascular accidents and her biggest health concern is urinary incontinence. Therefore, a care plan can be designed considering the health concerns such as cerebrovascular accidents, depression and urinary incontinence with the help of the sense frame work in order to provide health life. The care plan is following:
|
Need |
Goal |
Nursing interventions |
Rationales |
|
1. restoring the function after cerebrovasvular accidents |
Short term goal : To improve the individual’s level of functioning so that they can become independent and take initiative for the self-care. Link to senses : Referring to the above case study, Maria needs a sense of purpose. She needs a goal aspire along with purposeful activities and challenging per suites. Since few days back the patient had suffered from right frontal lobe cerebrovascular accident (CVA) due to which she developed a left-sided hemisphere sense of purpose would provide her purpose ful activities. |
1) Monitoring and diagoniss of the factors that contributed to the immobility of the patient. 2) Walking in the park for three times a day with the help of nurses would manage her problem related to the cerebrovascular accidents. 3) Motor skill exercises in order to restore the normal functioning so that she gain her independence again. 4) assisting with the activities of the hygiene , toileting and fooding.
|
1) According to Østbye et al., (2013), this intervention would help nurses to identify the causative factors that causes the cerebrovascular accident. 2) According to Knodel et al, (2015), walking in the park would help her to restore her normal functioning. 3) According to Mimi & Ho (2013) , motor skill exercises is the best for restoring physical functioning since it strengthen muscles 4) According to Alligood, (2013), it is excellent for CVA patients since it provides the personal hygenie and reduce the complications of the patients.
|
|
2. mange depression and anxiety |
Short term goal : Short-term goal for the patient is managing depression and anxiety for physical and mental well-being of the patient. This would manage her depression and boost her self-esteem and provide sense of independence.
Link to senses : Of six sense, sense of security relevant to the patient Maria as observed in this case study |
1) Provide a safe environment to the patient in order to reduce the sense of insecurity and decrease the anxiety and depressions. 2) Professional therapist can be appointed to treat the anxiety and depression at the same time. These therapy includes cognitive behavioral therapy which would help her to adjust her thoughts nad actions with the help of the professional. 3) Anti-depressants such as serotonin reuptake inhibitor can be administrated for immediately reduce the depression and anxiety of the patient. 4) Motivational therapy can be arranged for the patient for improving the communication skills and boosting the self-esteem of the patient. |
1) According to Ng, (2014), providing a safe environment to the patient is essential in order to manage anxiety and depression. The providing safe environment would give her a sense of security since she lives alone and feel abundant frequently. 2) According to Ramjaun et al., (2013), cognitive behavioral therapy is effective to reduce depression. Cognitive behavioral therapy would help her to adjust her thoughts and behave accordingly. 3) According to Vaingankar et al., (2016), antidepressant has effective short term effect since it reduce the depression and anxiety within short time span. However, it has a side psychological effects. 4) According to Nyunt et al., (2015), motivational therapy is effective for reducing the depression, especially for the elder patient. It would provide to build strong social network with the surroundings and community members. |
|
3. Managing the problem related to the urinary incontinence. |
Short term goal : Reducing the urinary incontinence of the patient Link to sense : Sense of significance related to Maria. Since she had urinary incontinence, she felt worthless. Management would provide her a sense of worth. |
1) Bladder training after delay urination after you get to the urge to go. This time is useful managing the patient. 2) Double voiding would help people to empty the bladder of the patient.
3) Treat leakage around the catheter by eliminating the leakage.
4) Fluid and diet management for the patient.
|
All of these parameters will help determine the adequacy of the urinary tract function (UTI). With the practise of decreased fluid intake even during the several hours before bedtime will be able to decrease the urinary retention incidence as well as the overflow incontinence thereby promoting some rest. Appropriate use of undergarments can be helpful in diminishing the embarrassing aspects of the occurrence of urinary incontinence The increase in the amount of fluids during the day will be able to increase urinary output and thereby discourage that bacterial growth. Additionally the consumption of alcohol, coffee, and tea tends to have a natural diuretic effect and which acts as the bladder irritants |
Conclusion
In conclusion it can be mentioned that the government of Singapore has taken commendable steps and has shown to have a great foresight regarding the health care needs of the older people in terms of the f demographic shifts as well as the mapping of health care that has remained an elusive problem. Although there have been rise of some problem due to the aspect of social engineering mentality that is generally associated with demographics. This demographics leads to the social policy plans that is involved in failing to recognise the fact that ageing itself is a diverse experience, which is other than the varying by race, race, religion and income. For provision of effective care to any of the group of patients involves being responsive to both their physical and emotional needs. Most of the patients want a care that is what an individual deserves and which should be unique for then patient. There are a diverse group of individuals who comprise of the elderly group which are related to the disorders of age. There are also certain spans a continuum which are required only on the minor adaptations along with the modifications which require the major one. This depends on the status of health of the individual. In order to provide care often educational interventions are also required. The circumstances of the individual older person along with his or her family as is experienced in the private sphere of the home or is shaped in many of the senses by the public sphere. This is generally demonstrated by the amounts which is available in Medisave and Medishield that can be taken out. There is also a need to match the needs of the older persons with their families. This not just exists as commodified services which tends to require a high amount of institutional processing or red tape. For the better welfare of its people, Singapore must be able to recognise the value of integration of the private and the public spheres in a better way.
It can also be deduced from the case above that the older adults who suffer from CVD tend become more dependent over time where there often rely on their families to support them during their deficits. However in the absence of the family, most of the time the patients rely on their care givers for support. On this term, there is the application of the various models of health care like the ageing theory, the nursing theory as well as the senses framework. These theories help to describe the ageing population on the context of the location of the population, the identification of the theories also help to distinguish among the major characteristics of the ageing population. Similarly there is also a differentiation of the gerontologic approach from a geriatric approach in caring for the elderly. It also can recognise the factors which is important to the delivery of effective care for the elderly. Most of the health care professions are most of the time noticeable for nursing. Additionally there is occupational and physical therapy, have recognized their role in the treatment of the elderly.
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