The Impact of Garling Analysis on Health Care Sector - Case Study Example

Running Header: Garling Report Student’s name: Instructor’s name: Course title: Date: Garling report Introduction In the past years, there has been a silent concern by the public about access to treatment in the public hospitals. The turning point was on that fateful evening of 25th September 2009 which affirmed the not uncommon occurrence. The occurrence highlighted the harrowing experience the public undergo while seeking medical treatment. Specifically was the touching story of Jana Horska and further confirmation by NSW health was a real eye opener which drew a public concern. In addition, concerns such as cash starved hospitals, staff morale and overcrowding all sprout out. Lastly the needs for reforms were necessitated by the Vanessa Anderson case of 24th January 2008 and the parliamentary inquiry according to Garling (2008a, p. 5). This review tries to identify the impact of Garling report on health care sector, aged care and new Registered Nurses. Overview of general findings and those in relation to aged health care Out of the public mistrust and discontent, the commission visited 61 hospital, interviewed various health stakeholders like; doctors, nurses, specialist medical colleges, professional medical associations and patients as a basis of situational review of atypical NSW health (Garling, 2008b, p. 1). The analysis affirmed the public discontent. It was noted that there was overwhelming of public hospitals by the population dynamics. An increase in number of elderly patients with chronic diseases that required specialized treatments and longer stay at hospital was noted with their visit standing at one-third of total visits. Further realizations such as the increase of young patients at emergency departments were noted this is in addition to mental health problems along drug and alcohol abuse (Garling, 2008b, p. 2). Further findings such as; the ever increasing medical costs were noted, work force concerns such as doctors shortage, nursing demographical composition that noted 22% of the workforce are supposed to be retiring by 2011, in addition to majority being junior and thus lacking senior ones to mentor and supervise them (Garling 2008b, p. 3). As a solution, wide ranging improvements like; patients’ need being paramount, review of doctors and nurses role by abolishing the rigidity as a measure to improving team work (Garling, 2008b, p. 4). The need to improve team is advanced by the need to improve clinical innovation and emergency agency, improving database management (Garling 2008b, p. 5). Lastly they noted there is need to adopt new concepts like ‘model of care’, which is a consensus by professionals on best way approach (Garling 2008b, p.6). The steps to achieve them would be through; embracing information technology to develop health information system, improved training of clinical officers, bottom driven innovation & research and proper supervision of junior doctors (Garling 2008b, p. 9 &14). Secondly improvement in ward handling to avoid further infections, note taking and concerted teamwork approach to treatment where there is an overall who is in charge (Garling 2008b, p. 9 &17). Desires like shifting the discharge time and work force reforms by senior nurses relinquishing administrative functions to focus on their core functions, imparting the concept of being multidisciplinary, improving on clinical rosters and ward reorganization (Garling, 2008b, p. 19 &20). Recommendations in relation to aged health care It is noted that the elderly faces unnecessary delays in discharge due their complex needs as noted by Garling (2008a, p. 57). This should be hastened since having a sedentary life leads to muscle tone loss thus it can worsen rather than attain the intended benefits. To curtail this, the aged should be booked at nursing home or aged care facility (Garling 2008a, p. 56). To support the above, investment in hospital in home programs should be paramount. The second observation of lack of aged care bed which further contributes to longer waiting time and blocked access should be improved on (Garling 2008a, p. 57). The third finding which relates to special need exposed the fact that most nursing homes do not accept them leading to overstay in acute hospital bed. Thus, the report recommends 12-week transitional placements in absence of aged care program. The fourth observation and recommendation related to guardianship tribunal who viewed hospital as the safe environment and thus do not treat applications with urgency, thus the need to prioritize hearing for patients on urgent need. On the treating the elderly patient more smartly, better models of care need to be enshrined by pursuing clinical innovation and enhancement agency to identify patients who are likely to be impacted negatively by overstay in hospital. Apart from this, early planning should be commenced by aged care assessment team so as to hasten discharge (Garling 2008a, p. 61). In addition there is need to invest more in terms of training remuneration in geriatricians to help address workforce issues while not forgetting the nursing staff as noted that at some hospitals shortage is worse that they employ guards to nurse the elderly. Lastly, they noted there is need to increase the number of psychogeriatric bed and implementation of an electronic medical record to ease data management (Garling 2008a, p. 67 and 68). Issues pertaining to aged care With ageing, majority of senior citizens are prone to opportunistic and chronic infections. This is affirmed by the fact that 3% of Australian populations have complex chronic disease and that one-third of total hospital visits are by those above 65 years (Garling 2008a, p. 40) and that there will be a 50% increase in over 5 years in the number of persons aged 85 presenting to an emergency department (Garling 2008a, p. 55). This calls for proper planning, co-ordination and management, through better co-ordination and treatment of these patients within the hospital system or treating them outside the hospital environment. The various issues pertaining to aged care includes; cognitive impairment, malnutrition of older adults in hospital, adverse events and morbidity in older adults in hospital, advocacy in the acute care setting for vulnerable and frail older adults and chronic, complex and elderly patients and coordination of care as stated by Garling (2008, p. 55). In this section, I will particularly focus on cognitive impairment and malnutrition of older adults in hospital. Cognitive impairment of older adults With advancement in age people become more vulnerable to cognitive impairment with a doubling of prevalence every 5 years (Rait et al, 2004, p. 243). Dementia forms the most common cause of cognitive impairment that is defined as significant memory impairment and loss of intellectual functions; it interferes with patients’ work, normal social activities and relationship with others. (Gonzalez-Gross, Marcos and Pietrzik 2001, p. 314). The disease is costly and can represent a greater health problem to an ageing nation or society (Laurin et al, 2009, p. 498). As noted by Garling (2008a, p. 57) being in the hospital and leading a sedentary life leads to muscle wasting and loss of cognition power, this is affirmed by Ohayon and Vecchierini (2002, p. 201) that there is a relationship between excessive daytime sleeping and cognitive deficits. Garling commission reported that, elderly sicknesses were related to co-morbidity, complexity, lack of physiological and functional reserve and a propensity for illness to be manifest in characteristic ways. Such include immobility, incontinency, instability and impaired intellect or memory. The disease can be controlled by engaging the elderly in physical activities which has been found to be productive in reducing the level of impairment. Lautenschlager (2008, p. 1027), notes that a six month program of physical activity provided a significant improvement. Further to help alleviate pain for those elderly people with cognition impairment; early and proper pain detection should be applied through pain awareness, pain inquiry, pain description and location (Royal College of Physicians 2007, p. 3). Finally reducing the days of admission at hospital is significant since there are no organized social activities as compared to home. This can be achieved through implementation of hospital at home concept (Garling, 2008a, p. 54). The above fear is attested and affirmed by Laurin (2007, p. 500), Ohayon and Vecchierini (2002, p. 207) that regular physical activity can form protective front for cognitive decline. Malnutrition of older adults in hospital While everyone is vulnerable to malnutrition, certain fractions of the population are more prone including the elderly. The major cause of malnutrition to the elderly can be noted as social economic and clinical (European nutrition for health alliance 2005, p. 3). The prevalence in geriatric hospital has been proved to have a prevalence rate of 30% to 60 %. The most contributing factors are depression, infections, sarcopaenia, falls, fractures, reduced autonomy and increased mortality (Gazzotti et al, 2011, p. 321). Nutritional requirements changes with increase in age, energy requirements slow down with advancement in age thus this should be compensated with sufficient intake of other nutrients (Beck et al 2009, p. 5). The most prevalent under nutrition for the hospitalized geriatric populations is the protein – energy cases (Gazzotti et al, 2011, p. 321). Patients who are malnourished usual take longer to recover, requires more medication and usually suffers. In addition it is reported that that people with gastrointestinal, respiratory and neurological disease related malnutrition have a 6% higher general practitioner consultation rate, are written 9% more prescriptions, and have a 26% higher hospital admission rate than people who are well nourished (Visvanathan, Newbury & Chapman 2007, p.11 ). Malnutrition in hospitals can be stopped through listening to aged, carers and the relatives; making all ward staff food aware; staff should follow their professions’ assessing malnutrition ethics and lastly having protected mealtime (Age concern 2006, p. 6). Nursing and workforce issues identified and their impact to a registered nurse According to the report, nursing issues identified includes; shortage of nursing staff that impacts on the quality of (Garling 2008a, p. 109). They noted the use of domestic staff, porters and security guards to provide assistance to the main staff. Apart from this, managers and clinicians said there were nurses (Garling, 2008a, p. 67), In addition, poor remuneration and ageing workforce accounted for concerns afflicting the nursing workforce (Garling, 2008a, p. 248). This is also linked to the high training cost and thus universities are not willing to offer more space (Garling, 2008a, p. 250). Other issues are; nurse recruitment and retention in rural areas, role stress and transition due to sub roles in the profession (Cruickshank, 2007, p.8). Lastly is the problem of senior nurses being engrossed with managerial functions rather than the core activity and monitoring of junior ones (Garling 2008b, p. 19 & 20). The probable impact from these work issues to new registered nurse includes an experience of work overload thereby meaning anyone who wants a stab at the profession must be well prepared and dedicated (Garling, 2008a, p. 251). This is conjoined with the observation of poor conditions for nursing staff (Garling, 2008a, p. 263). The shortage of the staff has lead to reduction of the quality of service offered at medical facilities since the unqualified personnel from other profession are enjoined to help. The issue of getting nurses into administrative level is good on promotional basis but a shortfall for the required number of practicing nurses, as they will spend most of their time in administration in addition to robbing the junior nurses of a mentor (Garling, 2008a, p. 263). Lastly, with the nurse shortage, at time it means working without leave for many years (Garling, 2008a, p. 264). The main solution lies with the nurturing new graduates by the nursing profession, investing more in terms of training remuneration for nurses to help address workforce issues (Cruickshank, 2007, p.9). Conclusion From the above discussions and observations no enough funds to employ , it is indeed true that the Garling report was long overdue. One critical observation is that with the growing of an ageing population and the need for redefined health care access and delivery this report was timely. As noted there has been disconnect especially relating to aged health care whereby little attention has been given. On the other hand the critical health stakeholders in form nurses have largely been neglected through understaffing and work overload, underpay, low morale amongst others yet they are integral part in the process of health service delivery. To try and correct and improve the problems, proper pay, increase in enrolment opportunities at training institutions, and improving working conditions are needed. In addition, re absorption of those out of practice back to the profession should be given a priority. Finally as a concluding observation, the concerns pertaining health care of the elderly should be majorly addressed through hospital at home while having a thorough follow up. References Age concern 2006, Hungry to be heard: the scandal of malnourished older people in hospital, Age concern, London. Amella EJ 2007, Assessing nutrition in older adults, issue No. 9. Beck et al 2009, appropriate use of oral nutritional supplements in older people: good practice examples and recommendations for practical implementation, SCC 945-01/09 European Nutrition for Health Alliance, August 2005, Malnutrition within an Ageing Population: A Call to Action. Garling P 2008a, Special commission of inquiry: acute care services in NSW public hospitals Volume 1, Sydney, Viewed on 2nd October 2011from: http://www.lawlink.nsw.gov.au/acsinquiry Garling P 2008b, Special commission of inquiry: acute care services in NSW public hospitals overview, Sydney, viewed on 2nd October 2011from: http://www.lawlink.nsw.gov.au/acsinquiry Gazzotti et al, 2003, prevention of malnutrition in older people during and after hospitalization: results from a randomized control led clinical trial, Age and Ageing Vol. 32 No. 3 Gonzalez-Gross M, Marcos A and Pietrzik K 2001, Nutritional and cognitive impairment in the elderly, British Journal of Nutrition (2001), Vol. 86, pp. 313–321. Herr K and Decker S 2004, older adults with severe cognitive impairment: assessment of pain, Annals of Long-Term Care: Clinical Care and Aging, Vol. 12, no. 4, pp. 46-52. Laurin D et al 2001, physical activity and risk of cognitive impairment and dementia in elderly persons, Arch Neurol, Vol 58, pp. 89. Lautenschlager et al 2008, effect of physical activity on cognitive function in older adults in risk for Alzheimer disease. JAMA, September 3, 2008—Vol 300, No. 9 Lea j & Cruickshank MT, 2007, Rural and remote health, international electronic journal of rural and remote health research, education practice policy Ohayon, M & Vecchierini, M 2002, daytime sleepiness and cognitive impairment in the elderly population, Arch Intern Med, Vol. 162, pp. 34-56. Rait et al 2005, Prevalence of cognitive impairment: results from the MRC trial of assessment and management of older people in the community, Age and Ageing, Vol. 34, pp. 242– 248 doi:10.1093/ageing/afi039 Royal college of physicians 2007, the assessment of pain in older people, retrieved on 5th October 2011 from: http://www.britishpainsociety.org/book_pain_older_people.pdf Vishvanathan R, Newbury JW & Chapman I, malnutrition in older people: screening and management strategies Australian Family Physician Vol. 33, No. 10, October 2004 Read More