The Role of a Geriatric Nurse Practitioners - Literature review Example

Literature review -341776   Introduction: What prompted Florence Nightingale to give up a life of luxury and become a nurse? This pioneer of modern nursing felt a passionate calling for a profession of service and selflessness. It is probably the same yearning of so many men and women, which continues to attribute an aura of distinct nobility to the nursing profession. "Geriatric Nurse Practitioners (GNPs) provide care to individual older adults and their families in a primary care practice", Kauffman KS, and Barlow AR (2000). This literature review focuses on maintaining the dignity of patients Dignity is the ability to establish a sense of self worth and self worth and self respect and to appreciate the respect of others. (Hodson Randy 2001) The national statistics news release projects that by 2016 AD the population of people of pension able age in the UK would be around 12,417,00 and by 2031 this will increase to 15,271,000. (Government (UK) News Release, 2004). Life span and quality of life have increased considerably in the global population, thanks to the advancements in Science. (Source: Geriatric Care Resource Centre, at Medscape.com). The Nursing and Midwifery Council (NMC) Code for Professional Conduct (2004) states that "all registered nurses should respect the patient as an individual and protect the interest and dignity of patients. (Source: Archives, "The Nursing Standard Co" retrieved on May 24, ’07, from http://www.nursing-standard.co.uk/archives/ns/vol20-18/pdfs/v20n18p4146.pdf. The paper outlines seven factors related to a patient’s privacy and dignity as mentioned by the "National Initiative on the Essence of Care", (Department of Health, UK, (DH) 2001a.). They are (1) Attitudes and behaviours, (2) Personal world and personal identity, (3) Personal boundaries, (4) Communicating with the staff. (5) Privacy of information (6) Privacy, Dignity and Modesty (7) Availability of an area for complete privacy The role of a GNP becomes all the more significant within the context of the above scenario. The personality of a nurse determines her degree of dedication and involvement in providing care. The literature review thus, begins with a look at the attitude of nurses in general, before delving in detail about the contribution of a nurse to maintaining dignity in geriatric care Dignity Dignity for the elderly is a "social-psychological state, a complex combination of the personal, social or the interpersonal." (George LK 1998). He observes "dignity is bestowed by others in the immediate social environment and exists independently of it" We all know that maintaining a dignified presence both in wellness and illness is the wish of every man, and a nurse, more than anyone can help maintain a patient’s dignity. But are they guidelines for nurses to use in practice that they may term as working towards this concept? The study "Nurses’ and Patients’ perceptions of dignity", conducted by Ken Walsh and Inge Kowanko does just that. It aimed to highlight perceptions of dignity, both of patients and nurses, come up with a definition of dignity (based on experiences recorded) and identify nursing practices that maintain or compromise dignity. . Interestingly, both patients and nurses considered privacy, respect and control as used essential parameters of dignity. The nurses also mentioned advocacy and time as parameters while the patients mentioned choice, humour and matter-of-factness as important for maintaining dignity. Studying the social processes in which the elderly engaged in, research identified that dignity was found to be the central focus of these processes. (Jacelon Cynthia S, 2003) Dignity was found to be comprised of two attributes, self-dignity and interpersonal dignity. Privacy was interpreted as an interface between the staff of the hospital and the hospitalized elders. The author discusses in detail with five elderly patients, the meaning of dignity. The elders pointed to the following strategies for affecting their dignity – (1) making meaning out of interactions with others (2) adjusting attitude (3)managing an image (4) and a reviewing of life Nurse, the caregiver Care and compassion embodies the profession of a nurse. Talking and listening to the patient, tailor the treatment according to preferences and lifestyle of patients, is a concept of nursing care that makes the profession a selfless vocation (Thomas Joan D et al, 2004). In an attempt to further improve their strategies nursing practitioners are investigating theories of the profession of care giving. The study highlights the care given to patients by a nursing practitioner. The study was based on the design of Schoenhofer’s Nursing and caring research praxis approach. The key informants were interviewed in their respective outpatient settings. The attributes of caring of a nursing practitioner (analysed from the dialogue data) were found to be love, respect, trust, mutuality, spiritual expression and enhanced personhood. The conclusions of this study, "Caring Relationships created by nurse practitioners and the ones nursed" (Thomas Joan D et al, 2004), laid down the following implications Spirituality proved to be a significant factor linking the caring and the cared in a remarkably positive manner Caring by the nurses created opportunities for enhanced personhood of the patients The enhanced personhood was more evident in patients who were nursed beyond physical needs The study concludes that the findings could have a great potential in the education of Nursing Practitioners. It also suggested exploring more avenues in this regards for research. The right attitude A geriatric nurse, besides being a good human being, has to be a compassionate individual with a well-focused, intelligent and motivated dedication to her clients and their caregivers. These qualities are believed to assist practicing GNPs in their pursuits as care givers to the elderly. Another prerequisite for a GNP is resilience to overcome the difficulties in caring for the aged. (Carol Esche A, (2005). Esche opines that older adults with resilient qualities are more successful as GNPs especially when it comes to care during the transition of the patient from hospital to home. The other side of the picture For every concept, the contradictory aspect juxtaposes itself to give one a complete picture within any situational framework. Negative attitudinal evidence in nursing practices are therefore prevalent with studies giving a clear picture of its main parameters. Courtney Mary and Marsh Ann (2000) in " Acute care nurses’ attitudes towards older patients: A literature review", explain that with increasing life expectancy and the growing number of elderly population, negative attitudes in registered nurses may observed. The paper reviews many recent researches in attitudes of nurses, both positive and negative, of nurses. The authors advocate for a research instrument that includes patient focus and a caring dimension. Among the themes of GNP found in a research conducted in Bangkok, tension in geriatric nursing emerged significant. (Tassana et al, 2004). The research consisted of in-depth interviews with older persons and their families. The research concluded that everyday practice of nursing was still a biomedical component rather than a practical interpretation of the holistic rhetoric of GNP. 51 female nurses participated in the study, "Nurses’ personalities, nursing related qualities and work satisfaction" (Sand Asa, 2000). It was found that most negative attitudes like tension, reduces dedication and attention to patients and patients’ abuse cropped up when job satisfaction reduced for the practicing nurses. In general, the goal of a GNP is to provide high quality cost-effective care to the elderly. However focusing effectively implies a broadening of the general perspective of a geriatric nurse. Paying attention only on the client and his/her family (Kauffman KS, and Barlow AR 2000) may be considered as narrowing of a GNPs perspective. They advocate, in the backdrop of today’s health scenario, a wider perspective on the part of GNPs that takes note of trends in health issues targeted for care of the older adult population. Training Needs of the Psychiatric Nurse It is important to specify in definite terms the additional training needs of the psychiatric nursing practitioner, in the changing scenario of an ever-growing adult population. In a paper entitled, “The education and training needs of qualified mental health nurses working in acute adult mental health services” (Jones, Julia & Lowe, Trevor, 2003). the authors present findings of a research study that investigated education and training needs of qualified psychiatric nurses. The study aimed to address a key knowledge gap, created because not much is known about the exact aspects of education and training that would be relevant to these nursing practitioners, especially for nurses working with acute adult mental health problems. . Specific goals of the study were to identify Post registration education and training for nurses to cope with acute mental health patients The nature in which the nurses wanted to be trained The kind of accreditation the practitioners expect after training The findings of the study confirmed the need for relevant training and education for nurses working with acute mental health patients. Psychiatric Nursing and dignity of patients Looking into a real life situation, Irma is a dementia patient, who kicks off her bed cover , pulls at her hair and keeps shouting for her friends, while people around (other patients and their visitors) look on. How does a GNP maintain the dignity of Irma? These are the kind of issues that re significant for research and for formulating standard practices for maintaining dignity. Depression, delirium and dementia are major health problems of elder adults. (Marx, Sullivan Dr. (2005). This calls for attention to be focused on the fact that there are not enough psychiatrists specializing in Gerontology, he points out. Alzheimer’s disease, arthritis, depression, osteoporosis, Parkinson’s disease and urinary incontinence also are issues that need much attention. According to him, research is needed to determine the associate risk factors for these disorders. A patient with mental health problems may not be in a position to realize and expect treatment with dignity. The psychiatric nurse thus has to resort to psychosocial interventions to provide care with dignity for the patient. The paper "Nursing care for the acutely ill psychotic patients" by Ruth V et al, 1950, is set on the premise that nurses have an important role in the psychotherapeutic programmes designed to treat the mentally ill. The "acutely ill" patients considered in this study are those who show two types of deviations from normal person. The first type includes patients who show an aggressive reaction, including patients with behavioral problems like schizophrenic excitement, agitated depression, temper tantrums and panic. The second type concerns patients who show signs of rejection of or withdrawal from the environment. Some of the types of behavioral problems categorized under this reaction are benign stupor, catatonic stupor, reactive depressions and withdrawal patterns of schizophrenia. They opine that reason and logic underline the principles of psychiatric nursing, qualities that can identify both the similarities and differences in the symptoms of different patients. Though treatment varies from patient to patient, the authors lay down the following principles to guide psychiatric nurses in providing care with dignity to mentally ill patients. Creating a psychotherapeutic environment Managing interpersonal relationships Protecting the patients and others Dealing with somatic problems Establishing and maintaining good personal hygiene Observing and recording observations Developing socialization The paper limits its discussions to the first two of the above aspects and observes that the psychiatric nurse should maintain an ongoing interpersonal relationship with her patient in the right environment. Here the authors give a detailed description of the environment, suggesting a clean, hygienic and cheerful environment, will tend to keep the patient calm. They also advocate an efficient planning and scheduling of tasks that will enable the treatment process function without confusion. This is especially important when the patients are extremely sensitive to the environment, say the authors. Therapeutic interventions of elder psychiatric patients Therapeutic interventions can immensely help patients in psychiatric wards. There can be various ideas for intervention. The article " Altruism and creative Expression in a long term older adult psychology group" (Bonhote K et al 1999), explains that altruism and creative expression are used as a psychotherapeutic intervention tool. The intervention are designed to help patients fell less powerless and also provides an insight into feelings, coping, preventive strategies for adaptation and to combat stereotypes, false beliefs and myths. A model for intervention for adult patients combining psychodynamic, supportive and cognitive behavioral approaches was designed. The authors use substantial clinical examples along with discussion on the therapeutic background, in order to illustrate a distinctly different group therapy for adults with mental health problems. The model emphasises the significance of the psychiatric nurse’s role in this intervention strategy. The authors conclude that such groups facilitate a contextual basis on which patients are offered a hope of relatedness, an opportunity for independence and a greater sense of integrity and possibility in later life. Intervention for dignity Another study looks into an intervention model in helping cope with patients who have suicidal tendencies. Suicide is a significantly prevalent health problem in Taiwan (Sun FK 2005). 41% of the people who committed suicide were earlier in-patient clinics in psychiatric wards. Intervention strategies to treat people with suicidal tendencies therefore assume tremendous importance. The study, "Nursing people who are suicidal on psychiatric wards in Taiwan: action/interaction strategies" (Sun F K et al 2005) adopted a qualitative approach and interviewed 15 patients with suicidal tendencies and 15 psychiatric nurses. The aim of the study was to formulate a suicide nursing care theory for enhancing and advancing the existing strategies of nursing. From the analyzed data emerged a substantive theory of nursing care that infused dignity as a prominent component. The study reiterated the need for excellent interpersonal skills on the part of the nurse for an ongoing psychosocial interaction with the patient, identifying four major areas of interaction. They were (1) Holistic assessment of patients (2) Providing protection to the patients (to maintain their sense of dignity and privacy) (3) Providing Basic care and (4) Providing Advanced care. Counseling Counseling is a nebulous term according to Rainsford Catriana (2002). In a paper titled “Counseling older adults” she explains that counseling refers to a therapeutic approach, that adds value to the person’s subjective experiences and challenges the person to accept responsibility for his or her own life, with dignity. She says that the overall aim of counseling is to help a person attempt to live his life in the way he considers most resourceful and satisfying. She says counseling may also include strategies like addressing and solving specific problems, helping the client make quality decisions that keep his dignity intact and coping with crisis There are many definitions for counselling. Frank Parsons was the first to use the term in 1908. Counselling focusses more on psychotherapy than the psychopathology aspect of the patient. (“Counselling” from Wikipedia, the free encyclopedia). Counseling helps a patient with mental problem cope with it and improves his general mental status with positive inputs for motivation It is very important for the patient to speak frankly to his counselor. (Lehavot, Kevin 2001). It was found in Japan, according to the essay “mental Illness in Japan, a need for change” that for people who knew English, they found it easier to talk to the counselor in the language rather than in Japanese, as it was difficult to express their fears and doubts in their mother-tongue. Counseling centres therefore encourage patients and their families to converse with the counselor in English if they are familiar with the language. The essay also points out to the aspects that inhibit optimum treatment of the mentally ill in Japan. One of the main challenges is the social stigma attached to mental illness (Grimes, Andrew, 2001). He says that a sense of shame pervades the family, when they have a mentally ill member. Having a mentally ill patient at home is akin to an assault on the family’s dignity. Another interesting aspect of the problems of the mentally ill in Japan is that those who know English can express themselves better at counseling centres. They are able to communicate effectively, in comparison to those who do not know English. (Lehavot, Kevin 2001) Communication is a very important aspect of interpersonal relations and counseling is a treatment option that functions only within a framework that has communication and interpersonal relations. (Caris-Verhallen, Wilma et al 1996) In the paper “The Role of Communication in nursing care of elderly people: a review of literature”, Caris-Verhallen et al speak of communication as a nursing topic. The authors describe the role attributed to communication in theoretical nursing models and also review research conducted in the last 10 years regarding the role communication plays in nursing the elderly. One of the significant aspects pointed out in the paper is that nurses use a lot of skills to treat a mentally ill patient, but it is effective communication, be it verbal (like a friendly “Hi”) or non verbal (like shaking hands or giving a warm hug) that accords respect and dignity to the patient being nursed. Alternative Therapies It is common knowledge that today, there are alternative therapies prevalent for the treatment of mentally ill patients like music, meditation, multi sensory stimulation, reminiscence and reality orientation. The review will look into some of these strategies. As psychiatry of old age became an increasingly essential tool to treat the growing numbers of mentally ill elders, so did psychological treatments grow., according to Charles twining. In his paper “Psychological Treatments” discusses in detail, various psychological treatments prevalent for treating elder psychiatric patients. They include psychotherapy, group therapy, family therapy, cognitive and behavioral therapy, anxiety management, grief counseling, therapies for dementia, and about the carers of the elders. All the strategies are explained in a practical manner with tables indicating a step by step approach. He concludes that more studies are needed to identify the best treatment for each patient as responses may differ to different strategies. Generalization is difficult, he says, as the causative factors, description of malady and symptoms vary widely. He advocates a multi-disciplinary approach for such studies, in order to evaluate elders. He opines that both psychological and pharmaceutical investigations are in order to develop an optimum treatment programme. “Music is another powerful tool for maintaining and restoring health”, says Maeona K Kramer in her paper called “A trio to treasure: The elderly, the nurse and music”. She explains that music can be used to induce relaxation and distract the patient pleasantly. The vibration characteristic of music helps the patient relax. According to her , music is “processed through the senses and integrated within the nervous system”. Nurses need to understand, appreciate and include music in the treatment process of the elderly. The University of Buffalo, Department of Psychology paper “Systems and Theories of Psychology” explains how mental illness was treated with hypnosis and mesmerism in the past. The course paper contains many useful links for the student to explore the subject in detail. Relevance to GNPs It is observed that with the increasing number of alternative therapies coming into the picture, a GNP, would have to further expand the domain of her knowledge and skills to be able to provide support, treatment , dignity and overall reassurance to the elderly psychiatric patients. Controversy In Psychiatry as in every other field, controversies loom large in the face of lacunae in research. One major area remains the prescription of medication for treating psychiatric disorders. Dr Loren Mosher resigned in 1999 resigned from the American Psychiatric Association, in protest against psychiatrists prescribing “quick fixes” for their patients. (Source “Psychology Today, Vol. 32, No. 5). The news report in the journal, “Are Psychiatrists betraying their patients?” lays forth the viewpoints of several psychologists about prescribing unhealthy drugs to their patients. Some doctors, in the report advocate the use of drugs as they are available only after significant research and successful trial reports. Dr Loren speaks of his success in intervening schizophrenic conditions in patients with counseling. The patients seemed to fare better with counseling rather than prescribed drug intake. He argues that drugs for the mentally ill are prevalent and prescribed because of the fact that millions of dollars are poured into making the drugs and pharmaceutical companies The report concludes with William Emmett’s words “all people have the right to make their own decisions. William Emmett, Chief Operating Officer of the National Association of the Mentally Ill. Conclusion Interpersonal relations are transient, dynamic interfaces that can snap or be strengthened by various factors that affect all parties involved. Research possibilities are endless, in this regard. For instance, the difficulties faced by various ethnic groups within a particular geographic context, due to lack of communication would yield important answers. The findings of the research could go a long way to reassure elders from ethic groups of their acceptance within the society and provide them with the dignity and status among peers. The review has moved from a simple definition of a caregiver to more complex issues that have significant implications in the care of the elderly and maintaining their dignity. There are numerous studies almost on every aspect of geriatric nursing of the mentally ill. However the scope remains as large as ever for more research. References Report “Are Psychologists Betraying their Patients?” Psychology Today, Vol 32, Issue 5, September-October 1999 Kramer Maeona K, “A trio to treasure: Music, the nurse and the elderly”, geriatric Nursing, Vol. 22, Issue 4, July 2001 Hodson Randy, “ Dignity at work”, ISBN Publication, 2001   Archives, “The Nursing Standard Co” retrieved on May 24, ’07. from http://www.nursing-standard.co.uk/archives/ns/vol20-18/pdfs/v20n18p4146.pdf George LK, “Dignity and the Quality of Life in Old Age”, Journal of Gerontological Social Work, 29, 2-3, 39-52, 1998   Walsh Ken, Kowanko Inge, “Nurses’ and Patients’ Perceptions of Dignity,”, International Journal of Nursing Practice, Vol. 8, No. 3, June 2002 Ruth V et al, “Nursing care for the acutely ill psychotic patient”, The American Journal of Nursing, Vol. 50, No. 1, January 1950   Bonhote K et al, “Altruism and creative expression in long-term older adult psychotherapy group”, Mental Health Nursing, 1999; 20(6) “Systems and theories of Psychology”, University of Buffalo, Department of Psychology, retrieved on May 24, ’07 from http://www.cas.buffalo.edu/classes/psy/segal/4212001/mental_illness_hypnosis.htm   Sun F K et al, “Nursing people who are suicidal on psychiatric wards in Taiwan:: action/interaction strategies”, Journal of Psychiatric & Mental Health Nursing, Vol. 12, No. 3, June 2005 Thomas Joan D et al, “The Caring Relationships Created by Nurse Practitioners and the Ones Nursed: Implications for Practice, Advanced Practiced Nursing e-Journal”, from Medscape.com (1/14/2005), retrieved on May 23, ’07 Top of Form Kauffman KS and Barlow AR, “Population focused care: a new rubric in the role definition for GNPs in primary care practice?”, Nurse Practitioner Forum, March 10(1), 1999 Cameron Swift G, “Care of older people- falls in late life”, British Medical Journal, 7 April, 2001 “United Kingdom population set to pass 60 million next year”, Population and Migration, UK Government National Statistics News Release, 30 September 2004 University of Iowa, News Release, April 12, 2002) News/Publications, Ralston Center -Quality of Life in Aging, March 27, 2006 retrieved on May 23, ’07 from http://www.ralstoncenter.org/news/news009.htm Carol Esche A, “Resiliency: a factor to consider when facilitating transition from hospital to home in older adults”, Geriatric Nursing, Vol. 26, Issue 4, July 2005 Marx Sullivan Dr., in the Conference on “Emerging practice and Policy Issues for GNPs”, Highlights of the National Conference of GNPs (September 26-October 2, 2005, Cleveland, Ohio), retrieved on May 24 ’07, from Medscape.com (http://www.medscape.com/viewarticle/518233) Tassana et al, “Nursing older people in Thailand”, Geriatric Nursing, Vol. 25, Issue 1, January 2004 Sand Asa, “Nurses’ personalities, nursing related qualities and work satisfaction: a 10-year perspective, Journal of Clinical Nursing, Vol. 12, Issue 2, March 2003 Courtney Mary and Marsh Ann, “Acute care nurses’ attitudes towards older patients: A literature review”, Scholarly Paper, International Journal of Nursing Practices, April 2000 Grimes, Andrew, ‘Counseling, Health Issues and Counselors in Tokyo and Japan” Web pages retrieved on May 23, ’07, from http://www2.gol.com/users/andrew/faqse.htm Lehavot, Keren, “Mental Illness in Japan: a need for change”, Web page retrieved on May 23, ’07 from http://artsci.wustl.edu/~copeland/keren.html Caris-Verhallen, Wilma et al, “The Role of Communication in nursing care of elderly people: a review of literature”, Journal of Advanced Nursing, 25, 1997 Jacelon, Cynthia S, “The Dignity of elders in Acute care hospital”, Qualitative Health research, Vol.13, No. 4, 2003 Rainsford Catriana, “Counseling Elder adults”, Reviews in Clinical Gerontology, 2002,12 Twining Charles “Psychological treatments” , Web page retrieved on May 24, ’07 from http://www.rcpsych.ac.uk/pdf/semOAP_ch17.pdf Read More