Challenges Faced by Nurses in Service Provision to the Elderly - Essay Example

Running Head: FAMILY HEALTHCARE Challenges Faced By Nurses In Service Provision To The Elderly [Name Of Student] [Name Of Institution] Introduction The range of roles carried out by nurses has developed just as the discipline of critical care. For example, the range of critical sickness consists of proactive care, management of the critical sickness and follow-up care as well as the practice of palliative care in the ICU setting (Considine, 2005).The roles of nurses included in nursing professionals involve; career; educator; patient and family advocate; coordinator; advanced practice; consultant; researchers; and a leader. Nurses are expected to exhibit these roles in their own area of expertise (Lloyd-Jones, 2005). In a Royal College of Nursing Australia (RCNA, 2009) media release - "New RCNA faculty to focus on healthy ageing", Ms Debra Cerasa (Chief Executive Officer, RCNA) proclaimed in part that healthy ageing can be a really positive process if it’s underpinned by good health and lifestyle principles and preventative measures. Nurses play a key role in aged care service provision across the spectrum of the national health care system. They are the health care professionals who currently spend the most time with elderly clients across the spectrum of health care services (03-Sep-2009). In this paper, I shall discuss the contemporary challenges faced by nurses in service provision of older people to assist in the process of healthy ageing. Also, I shall discuss other ways that should be canvassed for older people so that their requirements are met in a better and more effective manner. Discussion Usually older people are in need of care more frequently and also their duration of stay at health facilities is longer than that of younger people (Davis, 2008). In a survey carried out in year 2005, 12.1% of the Australian population consisted of people above the age of 65 years and they made up a total of 48% of people admitted to hospitals (ANMC, 2005). The figures have obviously risen since then indicating that older people remain the main consumers of healthcare services in Australia. As defined by the World Federation of Critical Care Nurses, critical care nursing is an advanced nursing care of critically sick patients who have evident disorder of crucial organ functions. It involves helping, supporting and reinstating the patient toward wellbeing, or to relieve the patients’ pain and to prepare them for a noble death (Ebserole et al, 2008). The intent of critical care nursing is to develop a therapeutic association with patients and their families and to build the patients’ physical, emotional, sociological, educational and religious potentials through preventive, therapeutic, and rehabilitative strategies. Critically sick patients are those who are at high danger of actual or possible acute health problems. Critical care nursing can be strongly linked to intensive care unit (Scribante, Schmollgruber, & Nel, 2005). The early stages of critical care nursing included mainly of coronary care unit, cardiothoracic units, and the general intensive care units. Coronary care units took care of cardiology patients, cardiothoracic units for postoperative patients whereas; general care unit took care for patients with respiratory problems (Ebserole et al, 2008). The principles of critical care nursing that exist today are as a result of later advance in renal, metabolic, and neurological management. Advancement in technology, such as the invention of machines like ventilators, cardiac monitors, pacemakers, defibrillators, dialysers and currently, intra-aortic balloon pumps have promoted the development of critical care as a specialty and of more expertise (Fairley, 2005). The recognition of the importance of the role of adequately trained and experienced nurses in these care units from an early stage have led to the development of nursing specialty of critical care. The development of critical care nursing in Australia was exemplified by a number of features: the foundation of a new organization between nursing and clinical staff; the experience of a vertical learning curve for nursing and clinical staff in accord; the guts to work in unfamiliar location, caring for terminally ill patients- a task that needed development of high-level of competence; and a high demand for education specific to the specialty of critical care nursing, which was at first hard to meet owing to the lack of qualified nurses in the field (Hanley & McEwen, 2005). Key Challenges There are many challenges facing nurses in service provision for the older people. For instance providing a philosophy of care that is person centered and holistic, being able to establish care systems that support person-centered care for the elderly, collecting personal history of patients, being able to establish a trusting relationship, to offer adapting environments to assist understanding rather than confusion, fostering care plans with stress on strengths rather than problems, providing a calm environment and best possible stimulation, having expert and sufficient staff, care planning with quality and funding (Jamison, 2007). Though each challenge mentioned above needs attention and planning, I believe that addressing the issue of workforce is of utmost importance and attached to it is the issue of workforce substitution, especially when we consider the future workforce requirement predictions and take into consideration the range of tasks that healthcare professionals in future will be expected to carry out (Ebserole et al, 2008). One healthcare service that most of the elderly people need is that of physiotherapy. Consider a scenario where the duties performed by a physiotherapist are expanded then it would ultimately mean that more physiotherapists are required, but if their current duties are delegated to other healthcare providers then in future less number of physiotherapists will be needed (Nay, 2009). Current research as documented in literature, therefore, prefers the term skill shortage to workforce shortage where the latter stresses on specific professions (Giummarra et al, 2007). It therefore, calls for proper channeling of policies. Steps For Better Service Provision Workforce planning is another area which calls for immediate attention. There is no doubt that there are issues with demand projection and technical setbacks which severely hampers the creation of formal structures (Giummarra et al, 2007). However, financial aspect is also to be considered when devising any strategy or plan. Restructuring of work spheres should be done with proper planned and mapped financial benefits to keep it going in the long run. The Australian Medicare schemes usually place rewards on medical practitioners to offer services to the elderly themselves, as usually, only services given by the medical practitioners draw a rebate in the structured schedule (Giummarra et al, 2007). This is not the case in reality as there are many services on the schedule which do not precisely require personal provision by the medical practitioner. For instance a pathology test does not necessarily require the presence of a medical practitioner and can well be carried out by medical students working there. Nurses also feel that there should be a proper strategy to promote flexibility in their job roles. The altering availability and the nature of the workforce in present times is the biggest challenge in addressing the needs of the older Australian population (Nay, 2009). Already there is the problem of an ageing workforce tending to the needs of the elderly, coupled with high rates of staff turnover and almost no capacity to attract new employees in this sector of healthcare. Also the acute sector offers better pay scales. Moreover these issues are expected to grow substantially in the coming years. The quality and standard of care provided by the nurses to the elderly population in present times is another area of concern. As it is, there is no state set educational requirements, competency standards or practice policies for people in the nursing fields and even for other unlicensed workers attending to the elderly. It is imperative that some standard be set for their education to achieve core competency in the least. Standards to regulate workload are required so that workforce shortage is met with and recruitment strategies become better (Giummarra et al, 2007). This also requires additional funding for the ageing population and recognition of the services rendered by the healthcare staff in this domain to retain the skilled people doing this valued work. The clinical competence of the nurse is essential concerning offering quality critical care. Clinical competence involves a combination of knowledge, skills, and behaviors. The ANMC developed a set of competency statements for specialist critical care practice, which consisted of 20 competency standards classified into six spheres: Professional practice; reflective practice; enabling; medical problem-solving; collaboration; and leadership (ANMC, 2008). However, a current study has questioned the validity of this structure as numerous competency statements were associated with more than one sphere. Hence, it is imperative to carry out more research to develop a competency model with enhanced construct validity. Currently, more competency spheres, and evaluation tools have been developed (Hanley & Higgins, 2005). Conclusion The issues discussed above strongly suggest that new strategies are drafted to facilitate reforms in the healthcare workforce. These strategies can be started by influential and responsible individuals in the healthcare policy field and then carried on to the state level. Such reforms can bring positive and innovative changes in the work area which will bring about independence and restore the much-deserved dignity in the care of older people (Nay, 2009). Old age does not mean extra reliance and trouble for healthcare providers (Davis, 2008). One can not deny that older people become less patient with their health issues and are difficult to deal with but that is because of the ageing process which brings with it a range of physical, psychological and social requirements that should be managed well in advance by healthcare providers to effectively serve the people (ANMC, 2008). This is also means that there is extra need for healthcare services that are both timely and responsive, allow choice and independence and also encourage person-focused ways of offering healthcare services by the nurses (Nay, 2009). This can be the first step to integrated care. A much-awaited change in the process of writing elderly citizens off has lead to the thought that old age is something to be cherished not despised and the needs of these people should be acknowledged and served with utmost respect and dignity. References Australian Nursing & Midwifery Council. (ANMC) (2006). National competency standards for the Registered Nurse (4th Ed). Dickson, ACT: ANMC. Australian Nursing & Midwifery Council. (ANMC) (2008). Code of ethics for Nurses in Australia. Dickson, ACT: ANMC Australian Nursing & Midwifery Council. (ANMC) (2008). Code of professional conduct for Nurses in Australia. Dickson, ACT: ANMC Considine J. (2005). The responsibility of nurses in avoiding bad events related to respiratory dysfunction: literature evaluation. Journal of Advanced Nursing, 49, 624-32. Davis, S. (2008). Healthy ageing in rural Australia: Issues and challenges. Australasian Journal of Ageing, 27(2), 56-60. Ebserole, P., Hess, P., Touhy, T., Jett, K. & Luggan, A. (2008). Toward healthy aging: human needs and nursing response (7th ed.). St Louis: Mosby. Fairley, D. (2005). Determine the kind of highly developed nursing practice in critical care: a critical care nurse consultant’s experience. Intensive Critical Care nursing, 21, 140-8. Giummarra, M. Haralambous, B., Moore, K., & Nankervis, J. (2007). The concept of health in older age: Views of older people and health professionals. Australian Health Review, 31(4), 642-650. Hanley, E., & Higgins, A. (2005). Evaluation of practice in critical care; students’ opinion of a clinical competence evaluation tool. Intensive critical Care Nursing, 21, 76-283. Jamison, J. (2007). Healthcare for an ageing population. Sydney: Churchill Livingstone. Lloyd-Jones, M. (2005). Role advancement and efficient practice in specialist and highly developed practice roles in critical hospital situations: logical review and meta-synthesis. Journal of Advanced Nursing, 49, 191-209. Nay, R., & Garrett, S. (Eds.) (2009). Nursing older people: Issues and innovations (3rd ed., Sydney: Elsevier. Scribante, J., Schmollgruber, S., & Nel, E. (2005). Perspective on critical care nursing: South Africa. Connect: World Critical Care Nursing, 3(4), 111-15. York, Springer. Read More