Community Health Nursing - Essay Example

Running Head: COMMUNITY HEALTH NURSING Community Health Nursing [The [The of the CommunityHealth Nursing In Australia at present there are a range of residential aged care facilities which-if appropriately funded, resourced and staffed-will provide the best possible care for those older members of our community whose health status dictates that they need care. Those facilities that provide quality care will be rewarded by an accredited status and receive ongoing funding. But the proviso contained above in the small word 'if is highly significant. If residential aged care facilities are facilitated by way of funding in their endeavors to provide the necessary care by appropriately qualified nurses, they will be able to meet the future with confidence. So too will their residents and potential residents. The enlightenment, fostered and driven forward by nurses and supported by consumers, can continue, but only if care of the aged is allocated its fair share of resources and strategies, such as relevant clinically based research, are encouraged to ensure the most appropriate use of those resources. (Duggan, 2004) This will only result from informed policies, which are clearly, in a fiscal and strategic sense, the responsibility of government; that is, the responsibility of those within government and its bureaucracy who inform, develop and implement policy. The use of the specter of dependency in the aged and ageing section of the population could lead to fear of ageing and contempt of this so-called unproductive group among younger people. These are certain major objectives of the Australian Community nursing Association which emerged initially as a result of nursing interest, but expanded rapidly to attract medical and allied health professionals. The mid nineteenth century has been described by some historians as a period of enlightenment that was born of the political, social and scientific revolution that occurred during that century (Mellish 1984). It was a fertile period of development for nursing, medicine and hospitals as establishments of care and learning. The emphasis from home to hospital care became apparent as an economically viable method of maximizing health care service and by the mid twentieth century was deeply entrenched as a societal norm for the sick and wounded. The relationship between older people and nurses was no social accident but a carefully thought out solution to a community need. The relationship between the nursing profession and older people as it was in the late nineteenth century remains today under threat from political and economic pressures exerted at many levels of the community. (Hitchcock, 2003) For example, a minister of the crown is believed to have expressed surprise that nurses working in aged care are paid as much as their counterparts working in critical care areas, such as emergency departments. The minister is further believed to have inferred that most older residents in aged care facilities are not sick, just old, and do not need skilled nursing care. Before addressing this question, and remembering the observations made earlier about the health of many older people, it must be stated that although many older people never need to move into residential aged care settings, there is a minority who do. And it is this minority, with their significant needs, who must not be abandoned or discriminated against by ill informed opinion driving or affecting policy, particularly regarding the qualifications and skills of their formal carers. (Baum, 2002) Are residents of aged care facilities merely 'old' or are they in fact sick This paper maintains that older people move into care because they are sick, not because they are living beyond a certain age. Their age is to an extent coincidental, although ageing changes and increasing longevity do contribute to frailty and disability. Qualified nurses do, as part of their role, care for the sick. The major issues facing older people in need of care in residential settings clearly reveal that they require skilled nursing and medical care. Residential aged care facilities are health care establishments where skilled staff are required to provide appropriate care within a framework of quality standards. As they are the final 'home' for many residents, care is delivered in an environment that approximates as much as possible their own homes. To support the argument for qualified and skilled nurses remaining the optimal workforce in residential aged care settings in both an operational and supervisory capacity, several issues relevant to older residents of aged care facilities will be expanded in this section. These issues are multi-systems disorders, earlier hospital discharge, high levels of acuity and associated care needs and responses to relocation to aged care facilities. That Australia's population is ageing has already been established. This phenomenon, together with advances in technology and a growing awareness of the need to adapt lifestyles to achieve longevity, has created significant numbers of older people living with multi-systems disorders. The nature of these disorders often leads to disabilities that exacerbate both physical and mental frailty. One result is that many older people require extensive, skilled nursing management. (Browning, 2004) Dementing disorders can also create a burden for older people, in particular those over 85 years of age. The progress of dementia itself leads to the necessity of specialized care and support. When dementia is concomitant with the multiple problems that are all too common in older age, such as osteoarthritis, osteoporosis, cardiac disease, chronic airways disease, strokes, neurological disorders such as Parkinson's disease, renal disease, liver failure and cancer, the resultant acuity requires highly skilled care (Onley 1997). As early discharge affects an older person's family and friends and community services, staff in residential aged care facilities receiving residents back to the facility, or newly admitting them, suffer if they have not benefited from consultation. The perception of staff in acute hospitals may or may not be that registered nurses working in aged care facilities will be able to provide sub-acute or, in some cases, acute care. The reality is that they can and do if they are well resourced with the requisite equipment, knowledge and skills. An obvious further requirement is that those registered nurses are in fact employed in residential aged care facilities supported by enrolled nurses. Facilities catering for residents with what are deemed 'low care' needs prior to an acute hospital stay and discharge may also be placed in the situation of receiving residents now needing a high level of care back to that facility. (Bernard, 2000) These will, in many cases, have no 24-hour registered nurse cover, and limited availability of enrolled nurses. Complexity of care needs indicates the necessity for skilled nursing care. Most people do not choose to move into aged care facilities- they have to move from home because of increasing frailty or illness, disability and the inability to cope with resources available to them and their families in a home setting. They need and deserve support, skilled care and a high level of resources, that is, a high level of care consistent with their acuity. This care cannot be provided by unskilled carers in under-resourced environments. Whether or not residents are admitted to aged care facilities via an acute care hospital or direct from home, they undergo the effects of relocation. They will be suffering from one or perhaps several chronic disease states, physical frailty, the cognitive dysfunction resulting from dementia, or a combination of all these. A transition, as do all life changes, can combine losses and opportunities. Enhancement of those factors that minimize personal loss while promoting personal satisfaction is a necessary imperative in the nursing care of older people changing their place of residence to live in an aged care facility. (Sax, 2000) Major losses they experience include losses of youth, health, productivity and independence difficult enough to face without the added burdens of illness and disability. Caring, empathetic individuals may certainly ease these losses, but the task of assisting newly admitted residents cope with them in the presence of illness is daunting for staff not specifically trained to do so. Physiological and psychological disturbances can result from transfer from one environment to another, a phenomenon described as a relocation stress syndrome by Manion and Rantz (1995). The major characteristics of this syndrome include increased confusion in older people, anxiety, apprehension, depression and loneliness. Added to these characteristics are the underlying perceived losses of support systems, familiar environments and health status. Nursing staff is crucial to those suffering the effects of relocation their presence is essential to recognize certain behaviors as manifestations of the psychological impact of moving to an aged care facility. (Allender, 2005) Inappropriate medication may result from failure to recognize the effects of relocation, especially among those who suffer from dementia. Highly skilled nurses, working within a multi-disciplinary team, should be able to recognize the presence of relocation stress syndrome and manage it appropriately. Any management that avoids the use of hastily prescribed and/or requested medications will avoid the potential problems associated with injudicious use of drugs in older people. There is no doubt that certain areas, namely rural and regional Australia, the health of indigenous people, private health insurance, and the anti-competitive practice of medical specialties require immediate attention by federal and state governments. But any progress of reform requires collaboration by the Commonwealth and states, the nursing and medical profession and most especially the Australian community. What is most evident is the need to stop the reform talk fest, stop piecemeal attempts at reforms based on market and competition policy and get on with the job of reshaping our health care system to meet the challenges. It is now time for action. Many nurses in Australia had begun to describe themselves as nurse practitioners by the early 1990s. However, not much had changed in the environment in which they practiced. There remain few opportunities for remuneration other than by direct billing of clients. Until the passing of the Nurses Amendment (Nurse Practitioners) Act 1998 (NSW) nurses have had no direct rights to prescribe medications. Myth and policy prohibitions surround the ordering of investigations such as x-rays and pathology tests where legislation does not preclude this practice. The controversial topic of liability and indemnity has not been comprehensively tackled. Until recently there had been a paucity of research or literature relating to the role in Australia. However, there was strong anecdotal evidence that nurses, through necessity and choice, had been providing comprehensive and expert primary care, midwifery services, mental health services, women's health services and public health services to the Australian community for many years. (Stanhope, 2004) States and territories in Australia have been watching the NSW Nurse Practitioner Project carefully and most have now begun a local implementation project. A number are directly based on the findings of the New South Wales research. Given the federal system and the state-based organization of many health services and regulation of health professionals, if the lessons from New South Wales are to be heeded, the most difficult aspect of implementing the different models of nurse practitioner services will be in negotiating with the local key stakeholders. The law in Australia is relatively straightforward-nurses are responsible for their actions on a daily basis, to extend their scope of practice will not diminish their accountability. References Allender J. & Spradley, B.(2005). Community Health Nursing Promoting and Protecting the Public's Health (6th Edition).Philadephia: Lippincott Williams & Wilkins. Baker, S., and Stacey, M. (1994) 'Epidemiology of chronic leg ulcers in Australia', Australian and New Zealand Journal of Surgery, vol. 64, pp. 258-61. Baum, F. (2002) Community Health Services in Australia.In J.Germov (Ed), Second Opinion: An Introduction to Australian Sociology. 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