Nurses Perceptions of Care Received by People with Mental Health Issues - Coursework Example

Name: University: Course: Tutor: Date: Summarative Research critique: Required to critique and discuss a provided research article "Nurses perceptions of care received by people with mental health issues in an acute hospital environment" The design of the study which was a qualitative methodology and it focused on the nurses views which were not enough for the suggestion of the findings of the study. This is because Carers and family members should be the major focus and are also recognized as major contributors in evaluating of care for their loved ones but its quite unfortunate that their effort has been under looked in acute care units by medical teams (Alzheimer’s Association, 1993). Hence there is need for them to be considered as important in the acute care unit, more so the Health professionals should respond to both the family members and person with dementia needs (Alzheimer’s Association, 1993). Family member obligation and carers should be a major focus of this study as its seen in recent literature that commented on their responsibility in the acute care setting. The dementia-specific quality care needs of clients in residential care current literature is relatively adequate, but their is no literature on the special needs required in acute care unit. A lot can be said by Patients about accessibility and high standard health services that meet their needs. On the basis of their feedback it can easily be known what is working out and measures to be put to enhance good care . For patients to be more frank than if they spoke directly to a health care professional or administrator their should be a survey that includes appropriate safeguards for patient consent and confidentiality to address this issue . the biomedical model has been relied on currently as a care in acute settings,this little indicates that staff training and practice are their to fulfill the needs of the increasing aged population. Development of literature to recognize different problems both a person with dementia has in an acute care setting and negative staff attitudes to this group of patients should be really emphasized due to high rate of increase of prevalence of dementia with age, (Alzheimer’s Association Australia, 1993, p. 30). Their argument on assessment of dementia people is that there is need for it to be major focus as its associated to nursing practice,This is because its hard for people suffering from dementia to report changes in their own condition. It has also been surpoted by Nay, Closs, Pitcher and Koch (2000) and Jacelon (1999). Cummings’ (1999) study Another design can be used for the study such as, A prospective research design that dwelt on measuring the adequacy of discharge plans created for elderly patients with dementia and takes Brauner et al’s (2000) argument who suggested that dementia assessment throughout the care prossess should include family evaluations . Further more , Cutillo-Schmitter (1996) brings out clearly that nursing family assessment is very useful “for identifying patient and family concerns, problematic care giving tasks and expectations” (p. 36). Nay et al (2000) also commented on this positively, they viewed that the family of dementia people is an unused resource of support for the acute care team. The sample taken for the study was not the representative of the population; hence the drawing of conclusion of the study can not be based on such. However the study should have included many different hospitals for the acquiring of information because information got from one hospital can not be enough to come up with the findings of study as we can see only 14 nurses views was taken. For example Cummings’ (1999) study findings was that family members are key element in the planning process as well as irrelevant resources to discharged dementia patients (p. 250). Simms, et al (1998) suggests that consultation of families patients and carers must be done at all points(from entry to discharge) (p. 60). Research study which involved the perceptions of caregivers of their responsibility in the discharge process done by Bull, Hansen and Gross’s (2000), found that the fundamental in guiding nurse practice is based on the role of family and caregivers in the acute care setting . All this depends on the fact that most family involvement in the discharge planning process, the functional ability level, independence and satisfaction was higher than in those families with little involvement in the planning phase of discharge. The positive aspect on the sample collection was on the way the data was taken (convenience strategy was adopted to identify qualified Nurses registered with the Nursing and midwife council, who were employed in the acute care trust on a substantive contract, working in an area where older people might be admitted), hence biasness was minimized. Despite the giving of the parcel to the Human Resource which may have compromised the validity of sampling, data collection was contacted well but the problem is that the sample size was to small, the allocation of each sample was done properly Analysis was based on focus groups data where a list of categories got from the previous data focus group was confirmed in the next focus group .The procedure was repeated 3 times. All this was done to gauge group importance and assisted the analyst to know when saturation had reached, hence energy and enthusiasm from the groups was observed. Such kind of analysis maximizes precision of the study, the results is repeatable. The interviews is supposed to be put in written then later analyzed to check for similarities and differences in the data using constant comparative technique (Glaser & Strauss, 1967; Byrne, 2001). Then discussion can be conducted till agreement is reached. Poor communication poor collaboration and incomplete documentation can have detrimental consequences for old people. For example Communication Nay et al (2000) suggest that there is evidence to support “that staff who are most successful in communicating... [With dementia patients]... use skills which reflect best practice” (p. 50). sets out a table of suggested strategies for effective communication strategies which was put in a table form by Hendryx-Bedalov (2000) in her article involved coping mechanisms for staff and carers of dementia patients. In this article its clearly shown that she engaged a practical approach to facilitate communication which is relevant for both the acute and primary care settings. Caris-Verhallen, Kerkstra and Bensing (1999) focused on the non-verbal behavior that was a key aspect of interactions between the nurse and dementia people. Basing on their study of videotaped nurse-patient communication. Caris-Verhallen et al (1999) consider the use of non-verbal behaviour such as affirmative head nodding, smiling and body positioning to be fundamental in order to “build rapport” with dementia clients in both community and acute care settings (pp. 808-818). Its true that hospital wards are often noisy hectic and there is no calmness. This affects the old people who might be made confused and disoriented. According to Kovach’s (2000) research which focused on slowing or stopping sensory nerve networks and imbalance in persons with dementia, its well demonstrates that susceptible to influences from the environment is as a result of dementia. Nay et al (2000) also commented on this positively on a project that involved in improving the admission and discharge practices of acute and sub-acute care facilities. However the value of decrease in stimuli in an acute environment was brought up clearly by Nay et al (2000), Drijfhout (1998) and Kovach’s (2000), Kovach (2000) also talks on stimulation of which he says that if its too little then its associated with a decline in the functioning of cognitive of dementia people and problems associated with their condition such as behavior increase. Sammut’s (1999) also supported the argument, of which she stated that both physical environment and emotional surroundings greatly influences the behavior. Cutillo-Schmitter (1996) suggestions also dwells on the same argument which is on care environment that utilizes, whereby he said, a “visual cues can also enhance an older adult’s sense of competence and security” (p. 40). Patients independence should be looked into where by in terms of environment it should favour their independence. For example the acute hospital environment setting should be in a way that it should promote independence, such as in finding different places such as the bathroom, the bed space, the dining space or other place. In orientation purposes the following has played important role: corridors being kept free from institutional things lying about untidily; the function of rooms should be indicated with symbols, colours, paintings, or other symbols are also seen to be beneficial (Day et al 2000). Movement of person with confidence can be influenced by both good lighting and correct use of colour and effective colour contrast creating in the environment (Wijk 2001). Someone’s personal history and needs is supposed to be known, in order to take care of the environment which is needed to fit the needs of calmness, staff presence and consolation, hence adopted. In this study all participants nurse expressed need broader introduction to mental health issues in general nurse curriculum. For example Sullivan-Marx (1996) in his study found out that nursing staff education is positively related to the decreased restraints use in acute care unitsas well as aged care facilities which has the lowest rate of restraint usethats is associated to nurse practitioners. Taylor’s (1998) study suggests that hospital administration “provide nurses with opportunities for inservice education workshops” geared toward the unique care of dementia clients to ensure appropriate practices (p. 20). Restraints in acute care setting family reactions which was studied by Kanski, Janelli, Jones and Kennedy’s (1996) found that between7.4% to 22% was the rate of aged people restrained in acute setting,and it all depended on the institution and its practices. These was shown in Sullivan-Marx’s (1996) study whereby it was found out that it was hard for professional nurses to identify or able to use alternatives to physical restraints for dementia people in acute settings. This above concept of Sullivan-Marx (1996) it relates to restaraint use restraints which is is a policy of restraint-free care and is taken as best practice. However interdisciplinary involvement that is aimed at restraint reduction has been recognized as a major factor on decrease of restraint use (Cohen, Neufeld, Dunbar, Pflug, and Breuer, 1996; Mayhew, Christy, Berkebile, Miller and Farrish, 1999). A case study conducted by Mayhew et al (1999) found that “restrained patients require more nursing attention than nonrestrained patients if monitored, released, and cared for according to restraint guidelines” (p. 307). With this in mind, Brauner, et al (2000) discuss the short term use of chemical and physical restraints upon dementia clients and point out that even though the use of such restraints is fraught with problems, potential benefits may be “extremely great” (pp. 3230-3235). Even so, Haddard (1999) contends that the use of physical and pharmaceutical restraints “in place of adequate staffing, careful assessment, knowledgeable caregiving, and sensitivity to our patient’s needs is morally unjustified”(p. 30). Nay, R., Closs, B., Pitcher, A., and Koch, S. (2000). For the improvement and development of best practice methods for dementia patients in acute care setting, their should be a research on the conflict between qualitative and quantitative research which has some relevance. Whilst Walker (2000) recognizes that evidence based practice appeals to the “notion that evidence is the ‘ground’ of the ‘real’... such a notion does a serious violence to other forms of knowledge” and the subsequent forms of best practice that arise from them (p. 20).Therefore the evidence practice related may not be the best. Walker (2000) argues that research methods that are based in qualitative modes “have as much, if not more to offer nursing than the randomised controlled trial and the double blind experiment” (p. 20). According to Woodrow (1998a) suggestion on Quality of life, he refers to it to be the key element to human approaches to care and studies of qualitative research. It has been taken to be valuable because caregivers is able to approach care and interaction with new perspectives. evaluation and monitoring of care should be constant and is taken to be essential,hence this is aimed at preventing petrification. Various systems are relevant ,useful and readily available eg. dementia care mapping,But unfortunately each can cause unsatisfactory results, the advantage of evaluation and questioning might over score the weaknesses (p. 893). There is an increasing essence t o relate the research that focuses on nursing practice to bring out clearly the role of Nurses and to improve matters related to discipline which is a key factor on best practice to deliverance for patients with dementia in the acute care setting., the literature suggestions focuses upon the unique needs of different cultures basing on further research on initiatives practices for patients with dementia. There is relevancy according to multi-cultural Australian society. People from diverse cultural backgrounds react to situations differently – “elderly people and [their carers], for example, often have fewer economic resources” – a relevant theme in acute settings where discharge planning plays a large role in the rate of readmission for patients with dementia. As Cummings (1999) writes, gaining an understand of the various cultural factors contributing to the discharge planning phase of an acute stay, “enable discharge planners to construct after care plans for diverse groups of patients more effectively and more appropriately evaluate the efficacy of these plans” (p. 257).Admission of old people in acute hospital is seen to be more common,they also stay in the hospital for long hours compared to younger people (Nay and Garratt 2004). 12.1% of the Australian population has people aged over 65years, and only 48% of all hospital days in 2001 was accounted for. The very year, between 40‑45 years as the mean length of stay for a female patient was 2.8 days,and that of faemale aged 85 years and above was 10.9 days (AIHW 2002). Its evident that older people are taken to be larger consumers of health care, They are also faced with physical and psychological stressors, Therefore there is high risk of them to experience, psychological and behavioural symptoms, general deconditioning, falls, loss of mobility and functional decline (Nay and Garratt 2004; Cassidy 2001). Approximately 33‑66% of older people under hospital care have higher chances to suffer from cognitive impairment (Dewing 2001; Tolson et al 1999) this a big challenge for hospitals because thir is increased chances of dementia people facing safety, calmness and familiarity in their environments (Zingmark et al 2002). There is a question on older people care weather it occurs on everyday practice, although much has been written about it(Packer, 2000). Reinforcing such heated disagreements, Department of Health (DoH, 2001) brought out major liabilities on nursing care standards to older patients in acute hospitals, which resulted to some of the core needs that have not been achieved. Similarly, there is high variability on quality of care received by older people in hospital, whereby he clearly noted that there could be some wards which are excellent, despite the fact that others are deficient in certain aspects. The persistence of negative attitudes towards older people and practitioners failing fully to involve older people in decisions about their care or treatment by older people and their relatives was the identified problems in (1999) report on Turning Your Back on Us. This may be due to practitioners who have inadequate knowledge on the older peoples (Nolan et al., 2002). There has been increase in the need for core changes to the NHS, as per the recent policy statements requirements, The NHS Plan (DoH, 2000), The National Service Framework for Older People (NSF) (DoH, 2001b) and The Information Strategy for Older People in England (DoH, 2002) are one of this,more so on older people care hospitals. Person-centred care,that involves patients making choices for their own care and treatment (DoH, 2001b, p. 12) supports such amendments which is the core to the NSF. Person-centred care recommends that learning of older people by practitioners should be at an individual level, this should go hand in hand with better understanding of the patient’s personal meanings, experiences and attitudes (Williams & Grant, 1998). Older people hospitalization can cause suffering and abnormal behaviours (Miller 1999). Changes in routine, environment or caregiver, are some of the stressing factors which affect negatively both older people and persons with cognitive impairment, this also can face pressing issues that exceed functional capacity through multiple and competing stimuli.. Its evident that older people have higher chances of complications after surgery, acute confusion occurrence in admission time, which is so challenging, and is normally expressed through anxiety, hallucinations and delusions, aggression and agitation, wandering, restlessness, rummaging and other related social behaviors (Miller 1999; Finkel et al 1996).Being in an unfamiliar and confusing environment in acute care hospital settings, can result to unnecessary behavior and are not necessarily dementia symptoms. This behaviours’ can be managed by psychotropic medication which is just the provision, physical restraint use, patient attendants who are specialized assignment(Werner et al 2002). Its also seen that apart from suffering for the person and family caused by such behaviours, with increased duration of stay, mortality, post‑hospital institutionalisation, and escalating health care costs results to poor outcomes during hospitalisation, (Schofield and Dewing 2002). Hospital experience environment adversely affects the overall wellbeing of older people is,hence there is need to improve and apply person‑centred perspectives in acute hospitals.its evident that Person‑centred is taken to be gold standard model,this has anabled it to receive much attension in both within sub‑acute and residential aged care for older people (McCormack 2004; Kitwood 1997). The development of Person‑centred care was facilitated by the bio‑medical view of disease which is seen to reduce the person to lower rank of only a carrier of disease or a abnormal functioning organ(McCormack 2004). Although there is no clear definition of person‑centred care (Edvardsson et al 2008), generally it involves and use of personal information in care, as well as considering a patient as a human being (Edvardsson et al 2008; Slater 2006).in addition patient choice respect as well as offering, caring of patient basing on patients life, and concentrating mostly on what can be done by the person instead of the what has been lost as a result of the disease which the blame can not be put on Physicians or nurses in the acute hospital settings, as its said that most health care staff try to avoid work load by ascaping time constraints. However,its evident that the best can be done for older people in acute care. acute emergencies, road trauma, undertaking of highly specialized and expensive tests, and conduct acute and planned surgery all this suites the Acute hospitals,. However, the needs of the major users of their services, old, frail people with multiple co‑morbidities and sometimes cognitive impairment can’t fit acute hospitals. Speed and and acute has been the major concern when it comes to saving life and consultation with the patient in acute care and this may not be an option, on the side of slower paced that is quality elder care, consultation and optimised stimulation is involved. Straightforward diagnosis cannot be expressed by typical older people with co-mobididies and frailty, Specialities such as neurology and orthopaedics means that staff knowledge often lies within these specialities in an acute hospital organisation this is an issue which can addresss work against a holistic approach and quality outcome for older people. when older people are admitted in acute hospital setting they are likely to suffer from the consequences such visits are known to induce. Despite acute hospitals are excellent for single diagnoses, rapid treatments, and short stays, As an alternative to acute hospital admission, older people could be admitted for triage which is the option acute hospital setting and this can be friendly environments that has professional staffs in care of older people, and multidimensional care needs could be better met. older people centres’ could be improved basing on relevant constitution, whereby role and function at community level health centres in which aspects such as ienvironmental adjustments for older people is included, The fundamental knowledge and skills for all staff is the key factor when it comes tocare of older people. If such needs are put in place in addition to continuous development of ‘older people centres, older people on diverse aspect needscan be met easily. Hence in conclusion Our parents and grandparents deserve better than what they are receiving currently. The literature suggests that the delivery of best practice is situated in achieving a number of goals identified as indicators of quality care; individualising the approach to the special needs of dementia patients focusing upon behaviour interventions, nutritional support and environment construction; developing strategies to minimise unnecessary cognitive and functional decline based upon an emphasis of rehabilitation in the acute setting; elimination of unique problems associated with the elderly and particularly those with dementia, including pain management, incontinence, under nutrition and pressure sores; and the “Determination of structural and process factors contributing to quality and cost outcomes across the continuum of care”, including the role of specialised education and training (Strumpf, 2000, p. 39 opportunities for members of the health care profession now exists to dwell majorly on their philosophy on individualized care, assessment of people and management that will majorly involve multidisciplinary team. The multidisciplinary team approach should address the major role of carers in who play a big role in the caring of patients with dementia. References Alzheimer’s Association Australia. (1993) Education and Training on Dementia: Issues and Policy Paper, September, 30-31. Jacelon, C., (1999) Preventing Cascade Iatrogenesis in Hospitalized Elders: An Important Role for Nurses. Journal of Gerontological Nursing, January, 25(1): 27- Cummings, S. (1999) Adequacy of Discharge Plans and Rehospitalization Among Hospitalized Dementia Patients. Health and Social Work, November, 24(4): 249. Brauner, D., Muir, J., and Sachs, G. (2000) Treating Nondementia Illnesses in Patients with Dementia. Journal of the American Medical Association, June, 283(24): 3230- 3235. Cutillo-Schmitter, T. (1996) Aging: Broadening Our View For Improved Nursing Care. Journal of Gerontological Nursing, July, 22(7): 31-43. Nay, R., Closs, B., Pitcher, A., and Koch, S. (2000) Dementia Project: Improving the Admission and Discharge Practices of Acute and Sub Acute care Facilities in Relation to People who are Dementing, October, Gerontic Nursing Professorial Unit, La Trobe University, Australia. Sullivan-Marx, E. (1996) Restraint-Free Care: How Does A Nurse Decide? Journal of Gerontological Nursing, September, 22(9): 7-14. Taylor, B. (1998) Dementia Care: how nurses rate. Collegian, October, 5(4): 14 -21. Kanski, G., Janelli, L., Jones, H., and Kennedy, M. (1996) Family Reactions to Restraints in an Acute Care Setting; Journal of Gerontological Nursing, June, 22(6): 17- 21 Cohen, C., Neufeld, R., Dunbar, J., Pflug, L., and Breuer, B. (1996) Old Problem, Different Approach: Alternatives to Physical Restraints. Journal of Gerontological Nursing, February, 22(2): 23-29. Haddard, A., (1999) Ethics in Action. RN, May, 62(5): 27-30. Kovach, C. 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Miller, L., Nelson, L., and Mezey, M, 2000 Comfort ad Pain Relief in Dementia. Journal of Gerontological Nursing, September, 26(9): 32-49. Williams, J., and Rees, J. (1997) The use of ‘dementia care mapping’ as a method of evaluating care received by patients with dementia – an initiative to improve quality of life. Journal of Advanced Nursing, February, 25(2):316-323. Packer, T, 2000 Does person‑centred care exist? Journal of Dementia Care, 8(3):19‑21. Schofield, I. and Dewing, J, 2001 The Care of Older People with Delirium in Acute Care Settings; Nursing Older People, 13(1):21‑25. Strumpf, N. (2000) Improving Care for the Frail Elderly. Journal of Gerontological Nursing, July, 26(7): 37-43. Read More