NURS3003 Dynamics Of Practice 3

Introduction

Consumer-directed care (CDC) is embraced in Australia as an important means of promoting patient’s autonomy and selection of the choice of delivery of the health and the social services (Commonwealth of Australia, 2012). The following essay is based on the analysis of the healthcare and personal needs in order to ensure special focus over the independence and mobility needs of an older adult named Martin Chen. The aim of the essay is to advocate patient to stay at home not to go in an aged care facility. In doing so, the essay will initiate analysis of the main needs of Martin followed by resources that will be important to satisfy his needs. This will be followed by role of the registered nurse in assisting patients and his family members to avail the service and liaising with the required health care personnel. At the end, the essay will provide rationale behind importance of staying at home for the older adults.

Identified care need

The analysis of the case study highlights that Martin Chen who is at present 78 years, mild be suffering from initial stages of dementia. Brataas et al. (2010) stated the older adults who are above 65 years of age are vulnerable towards developing neurodegenerative disorder like dementia. As per the case study he is forgetting English terms and phrases while communicating, while the stove remains unattended with burning food. Kosse et al. (2015) stated that loss or fragment loss of memory is the initial stage of dementia associated with hallucinations. Chen also hallucinates as he cries at night feels that he is back in Hong Kong or tells daughter that someone has poisoned the garden soil. Thus the prime care needs assistance in daily living activity in order to promote independence and mobility needs through physical activity. According to Clarkson et al (2018), older adults who are suffering from dementia, a neurodegenerative disorder are prone to accidental fall. Thus, safety is also an important concern. Assistance in physical activity will help to manage the escalating weight of Martian and at the same time will improve the flexibility of the muscles and joints and thus reducing the chances of accidental fall. Reduction in the body mass will help to reduce blood glucose level (BGL), severity diabetes and cardiovascular problems and thereby increasing the overall health status and giving independence to lead an independent life (Gill, Bartels & Batsis, 2015).

According to Hill, Hunter, Batchelor, Cavalheri and Burton (2015), older adults who are suffering from dementia are prone to accidental falls and thus increasing the chances of getting injured. Injury related to accidental fall leads to pain and at the same time hampers the independence to conduct the daily living activities. The systematic review and meta-analysis conducted by Giné-Garriga, Roqué-Fíguls, Coll-Planas, Sitja-Rabert & Salvà (2014) highlighted that regular practice of mild to moderate physical activity helps to reduce the chances of accidental fall among the frail older people. Individualised home based physical activities can helps in the improving mobility, balance and muscle strength and thus helping to improve the physical independence (Burton et al., 2015). Blondell, Hammersley-Mather and Veerman (2014) highlighted in their longitudinal study that physical activity in dementia helps to reduce the cognitive decline of the older adults. The reduction in the cognitive decline in Martin will help to improve his level of independence in conducting daily living activities.

The case study highlights that Martin hails from a Buddhist family. He thinks that visiting temple will provide much needed time and relaxation. However, for visiting the temple, he needs to reply on his children. Regular visit to the Buddhist temple in Adelaide will help to improve his mental well-being and at the same time will help to work on his aggressive behaviour. Ennis and Kazer (2013) stated that spiritual nursing interventions helps to improve the mental and the physical well-being of the older adults with dementia. Martin also loves to do vegetable garden thus assistance in conducting gardening activities will help to improve his self-confidence and mental well-being and can be identified one priority of care. The last care needs will be weekly monitoring of the BGL, blood pressure and blood cholesterol. Gonzalez and Kirkevold (2014) stated that sensory gardening and horticultural activities in the dementia care help to improve the well-being while reducing the disruptive behaviour.

Thus overall it can be said that main care need of Martin is restorative care through home-based services. Cochrane et al. (2016) stated that restorative care for the older adults helps to reduce the functional decline while improving the independence.

Identification of the resources

The main resource that will be helpful in order to support the comprehensive care need include a home care package in order to continue living at home. Part of Silver Chain Group (2019) in Adelaide provides personalised packages for the older adults in order to lead a healthy life. The main support that Martin needs include allied health and therapy services like fall prevention (by personal support and by the use of walking aids and installation of grab rails), restorative services and physiotherapy for planning of the mild to moderate physical exercise. Providing manual assistance to attend Buddhist temple daily or once in a week by care as per Martin’s will. Specific support for improving his memory like community based group activities. At present Martin’s condition does not demands personal care services like showering, dressing and grooming and thus can be omitted for the service.

Silva et al. (2013) highlighted that elderly people needs informal caregivers in order to maintain mental and physical well-being and at the same time lead to healthy life at home and decreasing the need of moving to aged care facility. The informal caregivers in case are the family members of Martin. The informal caregivers will be trained to provide Martin assistance to continue his hobby of vegetable gardening. However, in order to reduce the chances of the accidental fall the pavement of the pots can be raised so that Martin is not required to bend to water the plants or installation of pipes for watering of the plants. The family members of Martin will be trained regarding periodic monitoring vital signs of Marin like use of glucometer for BGL, digital sphygmomanometer to record blood pressure. For monitoring of the blood glucose level, assistance can be taken from the Australian Department of Health (Ageing and Aged Care, 2019). By giving a call to this toll free number 1800 200 422, help can be availed for the conduction of blood test. The Australian Government funded initiatives, Commonwealth Home Support Programme and also be avail in order to assist Martin to accomplish his daily living activities.

Role of registered nurse

Registered nurse plays a vital role for comprehensive service delivery to the older adults under home settings. They hold the key management role in operational planning, coordination in the care plan, delivery and monitoring of evidence-based practice and creating provision for the continuous quality improvements (Goodwin et al., 2013). The presence of the registered nurses provides clinical supervision and nursing leadership in order to facilitate the complex health needs of the older adults like Martin. For Martin, the duty of the registered nurse will be to design person-centred care plan. The person centred care plan for Martin will be designed for physical activity promotion as per the mobility quotient of his joints. This will be done by taking help from occupational therapist and physiotherapist. Toots et al. (2016) stated that high-intensity physical exercise will be helpful of older adults and at the same time will help to reduce the high BGL.

Person centred care plan for Martin will include developing of the gardening activity planning for Martin under the assistance of the occupational therapist so that it might help to improve the mental well-being of Martin while reducing the chances of the accidental fall (Wiseman & Sadlo, 2015).

The registered nurse will also educate the informal care givers or the family members of Martin about the importance of the timely intake of medication and monitoring of the vital signs of Martin in regards to his age and present status of the forgetfulness. It is the duty of the nursing professionals to engage the patient in the care plan by disease education in order to improve the therapy adherence (Kornhaber et al., 2016). For Martin education will be given in the domain of effective weight management and adherence of physical exercise to promote self-management skills and independence. Silva et al. (2013) stated that family members at time suffer from burnout and compassion fatigue. In order to overcome the same a holiday or day out is found to be effective. The duty of the registered nurse will be to help Martin daughter and his family to enjoy an outing while arranging required support at home by taking assistance from Commonwealth Home Support Programme.

Benefits of transitioning at home

Parsons et al. (2013) stated that providing restorative are while at home helps in improving the mental and the physical well-being of the older adults. While staying at home enable the older adult to stay under the known social support and informal carers and this help to improve their level of confidence and inner-strength and thereby providing benefits in the grounds of the mental health and well-being. The staying at home for Martin will also provide him the independence. Martin is from China so staying at home will help him to remain culturally safe and thus helping to remain high on self-esteem.

Conclusion

Thus from the above discussion, it can be concluded that main care needs for Martin is assistance in physical activity, gardening, visiting to Buddhist template along with regular monitoring of vital signs. The Commonwealth Home Support Programme and other privately funded organisation provide a comprehensive assistance to the older adults which help them to lead to healthy life while staying at home. The duty of the registered nurse will be to assist the allied professionals in designing of the person centred care plan along with promotion of the disease education to both the patient and their family members. Sating at home for the older adults help to promote mental wellbeing and cultural safety and thereby helping to increase the physical well-being.

References

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Blondell, S. J., Hammersley-Mather, R., & Veerman, J. L. (2014). Does physical activity prevent cognitive decline and dementia?: A systematic review and meta-analysis of longitudinal studies. BMC public health, 14(1), 510. https://doi.org/10.1186/1471-2458-14-510

Brataas, H.V., Bjugan, H., Wille, T. & Hellzen, O., (2010). Experiences of day care and collaboration among people with mild dementia. Journal of Clinical Nursing, 19(19?20), pp.2839-2848. https://doi.org/10.1111/j.1365-2702.2010.03270.x

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Giné-Garriga, M., Roqué-Fíguls, M., Coll-Planas, L., Sitja-Rabert, M., & Salvà, A. (2014). Physical exercise interventions for improving performance-based measures of physical function in community-dwelling, frail older adults: a systematic review and meta-analysis. Archives of physical medicine and rehabilitation, 95(4), 753-769. https://doi.org/10.1016/j.apmr.2013.11.007

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