Intensive Care Patients - Essay Example

Discuss the Potential Implications of the Attitudes of the Registered Nurse Towards the Work of Caring for Older People. Introduction: The nurses’ attitudes towards the older people strongly influence their work of care with them. There is, indeed, a distinction between nurses attitudes to older people in need of care and the context of their work from the structural point of view. Some nurses do indeed feel negative about working with the aged; however, these negative attitudes are not reflected in the care given, rather attitudes express themselves in a variety of subtle ways. This may affect the quality of care and the necessity of care within the ethical and legal frameworks. Like all citizens, the elderly also have the right of choice with opportunity to select independently from a range of options with maintenance of all rights and entitlements associated with their citizenship. Like other human beings, they must be able to sense the potential for fulfillment through realization of personal aspirations and abilities in all aspects of daily life (Tulloch, 2005, 203-204). The most important right perhaps is to avail promotion of independence through the opportunity to think and act without reference to another person. Moreover, every care, irrespective of the attitudes of the care professionals, must comply with their rights to privacy and the right to dignity through recognition of the intrinsic value of people by respecting their uniqueness and their personal needs. Therefore, the ideal nursing perspectives and attitudes must tend to such rights to conform to the quality and standards of care. Practically applied, the older person may not be able to carry out all the activities of an independent daily life, and the care should be directed to achievement of those. Some may be achieved through the care process; those which are achieved should be maintained. Some may not be mastered, and the nursing care process should be directed to create adaptations in those areas. This can never be accomplished without a positive attitude from the nursing care professional (Paillaud et al., 2007, 274-279). The older person is not just the constellation of different disabilities and deficiencies; all of these have effects on the whole person. This demands a different positive attitude towards their needs, where care deficits of the whole person are attended with an eye towards meeting the quality standards of service. The nurse could literally serve as a change agent to these elderly people, where the health-related quality of life is improved. This positive attitude can be expressed only by demonstration of respect to the older people with maintenance of their confidentiality, by involving them in all decision making processes through appropriate and effective communication (Lester, Tritter, and Sorohan, 2005, 1122). Following these principles would go a long way to encourage the elder in need of care to be as independent as possible, and this would never be achieved with a negative attitude. There is now definite evidence that allowance of choice and control to the elderly contribute to positive health outcomes and enhancement of health-related quality of life. Loss of control about ones own self leads to ill health, psychological distress, and increased mortality. The facilitation of older peoples autonomy and their rights in their care is a professional art for the nurses where knowledge, understanding, sensitivity, skills, and attitudes are imperative. This can be a challenging as well as satisfactory career proposition for the nurses, only if they have a positive attitude towards the elder care (Penson, Daniels, and Lynch, Jr., 2004, 343-352). In reality, however, it appears that the attitudes of the nurses are not sufficiently positive, as it would have been necessary. Literatures suggest prevalence of ageism in the field of nursing. Nurses working in long-term care settings dedicated to the elderly and infirm are considered lower in status, and progressively less and less nurses are opting for specialization in geriatric nursing, while the geriatric population in need of care is progressively increasing. A very minute proportion of the registered nurses practice geriatric nursing, and most academic nursing programs lack courses in geriatric nursing (Spinewine et al., 2005, 935). Apart from these factors, this negative attitude is mainly the result of ignorance and misconception about the elderly and their care needs. Nurses have been shown to stereotype the elders by labeling them as inflexible complainers who are stubborn enough to compromise. This negative attitude would be more prevalent if nursing education and work experiences are not directed to this problem, which are projected in an aggravated fashion by the long-term care industry which stereotype the elders as least capable, least healthy, and least alert (Twomey, McDowell, and Corcoran, 2007, 462-464). The socially defined knowledge and experience of nurses are important determinants of their attitudes to the people being cared for. Social knowledge is a feature of culture, and the other features that determine these collective perceptions are attitudes, values, and behaviors. Nursing practice is strongly influenced by group dynamics. Thus the exploration of attitudes collectively would be useful in investigating the social, organizational, and environmental contexts of nursing practice in the aged care. In the contemporary clinical environments, it is mandatory for the nurses to demonstrate more proficiency in needs assessment of both the clients and their families in terms of management options and care strategies, and this is not possible without a positive attitude (Davidson et al., 2003, 47-53). It is a common perception of the nurses that work with elders is not interesting, and many dislike working with them. The reasons are heavy workloads, difficult work environments, and low incentives. There is a vicious cycle inherent in this. A negative attitude would fail to promote independence in elderly who are cared for, and high dependency levels of the older people in a highly unequipped structure of nursing work in the hospital environment would promote more dependence. This would hamper the favorable impression about work with the older patients (Thompson, Barbour, and Schwartz, 2003, 1011). Taking the example of current recommendations of using a Geriatric Depression Rating Scale in all older patients, it is evident that the attitudes of the nurses matter. Many older people in need of care have depressed mood or depression, and detection of that is important for designing adequate treatment for these individuals so the outcome of inpatient care is transformed and improved. A depression screening tool specifically designed to detect depression in elderly people is very acceptable, but despite apparent acceptability by the patients, the nurses attitude towards its use is rare. This negative attitude culminates into failure to explore areas for improving practice and outcomes of care. The main reason was that many nurses had a negative attitude towards the need of antidepressant treatment in the elderly (Hammond, 2004, 189-192). The only way to change is to change training experiences that refute the conception that old age must involve disability and illness and enhance the positive attitude of the nurses to enable them to understand the individual needs of the older people. While a negative attitude tends to disengage the older person from the society, a positive attitude can perceive the elderly as not socially inactive or isolated, rather as people who occupy active but alternative lifestyles to the young. According to role theory, the whole phenomenon can be interpreted in a different manner, when the care professional has a positive attitude. For example, the older person has a non-worker status whose knowledge, values, and general abilities are largely redundant. This creates a negative attitude leading to relative indifference and overt rejection of the elderly. This status generated by role loss and role ambiguity is also subjected by stereotyping and exclusion, largely results of negative attitudes. Elderly are the people with the highest level of disease, disability, social and economic problems that are likely to affect health and health-related quality of life in the community (Horrocks et al., 2004, 689-696). If needs assessment is basis of healthcare allocation, it is important to understand the requirements of the elderly, and defining their problems is the first important step towards this. Research has repeatedly shown that without doubt, the central problem is pervasively negative attitude of the society in general, of the care professionals, relatives and patients, to the health prospects of the elderly. Predominantly negative characteristics are often attributed to the older people as a group, with such opinions often being strongly held without being questioned. This has happened with the nurses due to insufficient vocational training in preventive care of the elderly people. The result is that the nurses tend to treat any symptoms as simply the price of ageing. Inadequate health education of the elderly and relatives, as a result, would lead to underreporting, which in turn would be compounded by under-recognition and under-treatment by the care professionals. There are predisposing factors for this. The current academic curriculum of the nurses generates a tendency to see their tasks concerned exclusively with curative medicine, and in contrast, the older people are more concerned about disability, dependence, and displacement from the society as they become less mobile and more isolated with advancing age. All of these cause the elderly with undue suffering when they suffer from age-related conditions such as sensory impairment, joint disorders, muscle weakness, depression, and alcoholism (Bruce et al., 2004, 1081-1091). While perturbed by role loss and role ambiguity, the older people are often actively excluded from equal opportunity for participation. The positive attitude of the nurse professionals should arise exactly from this point. Ethically, being older is no reason for discrimination, and a nurse has no right to do this to people who due to their frailty are deprived of many areas of social life, such as, work, politics, community and recreational activities. Otherwise, this discrimination may take various forms of victimization, even to the extent of direct injury. The nurses must develop positive attitudes so that no segregation any form is ever directed to the elderly, no prejudices ever expressed towards the elderly, and never a negative punitive action is undertaken by them. This can be achieved by positive attitudes, where attitudes represent the primary sources of social action. Attitudes consist of cognitive, effective, and behavioral elements. A positive attitude thus would comprise of positive cognitions and beliefs about elderly persons and their issues, positive affects or feelings about them, and behavioral tendencies that are in synchronization with the attitudes cognitive and affective elements (Puig Ribera, McKenna, and Riddoch, 2005, 569-575). As with all caring professions, nursing promises to the highest standards of care with a commitment to treatment and meeting the personal and social needs of patients and clients. While nurses still play a major part of care of the older people in the community, it would be an unfortunate revelation that a negative attitude and prejudice against the needs of the older people would create discrimination in care delivery, that they prefer to work with younger people, and that they definitely hold negative attitudes towards the elder care. Applying this knowledge into geriatric pain care, the negative attitude would lead to undertreatment of pain, which in reality is a significant problem. It has been demonstrated that even when the elder care residents was not receiving pharmacological treatment of pain, the staff member who is expected to know the care of the resident best, preferred to ignore the symptoms thinking that the resident was receiving the treatment (Lövheim et al., 2006, 257-261). When it comes to quality of nursing care, attitudes are of utmost importance. Studies on attitude towards older people have demonstrated that on the positive to negative attitude continuum, attitudes towards older people range between neutral to negative. This has been demonstrated repeatedly in various studies on health care professionals. Attitudes towards people with dementia, most of whom are elderly, have been studied from different angles and various approaches. These encompass nurses feelings about dementia care, attitude towards euthanasia for patients with severe dementia, enteral feeding, and older adults in the nursing homes. It has been observed in general that most of the nurses have negative attitudes towards these people, and more negative attitudes were associated with less strain and less satisfaction with work (Hall, Vogt, and Marteau, 2005, 614-616). The study of Norbergh et al elucidate that a change of attitude of nurses is on the wake where nurses attitudes towards people with dementia were positioned towards the positive to neutral ends of the continuum. This has significance from the personhood perspective. The aim of the person-centered care for these people is to maintain self despite diminution in cognitive skills. It has been highlighted that a persons self is largely a derivative of the way others look upon and deal or the way other look down upon or ignore. From this point of view, with a more positive attitude towards older people with dementia, the prerequisites of person centered care would improve. This also has a larger implication. It is imperative that the interaction between an elderly individual and the caring nurse is a helping relationship. This imposes ethical demands on the care professional even if the persons actions cause physical and emotional harm to the nurses. This sense of physical and emotional harm in a care relationship would not appear that harmful only if a positive attitude is employed towards these persons in need. Only with a positive attitude, the care behavior may enhance the patient satisfaction and promote their health and psychosocial well being (Norbergh et al., 2006, 264-274). The direct result of such positive attitudes of nurses towards the elderly is the need of the hour. Most of our health care systems have lack of health and social care provision for the older people with multiple and complex needs. A negative attitude would lead to the common perception that older patients are mentally and physically dependent, and the negative attitude is so engrossing that when pressurized work schedules take precedence, the nurses tend to prioritize the meeting of the physical needs only. On the other hand, a positive attitude would facilitate the condition of the older people better by the nurses, and when nurses are able to advance the care of the older people, they have been able to do so through psychosocial approaches rather than medical (Berry et al., 2007, 552-562). With a positive attitude thus, the nurses can provide high quality care and treatment regardless of age and care to the older individuals with respect and dignity. The care which the older people require to prolong and optimize their functioning would be in the psychosocial domain, and thus the skills, understanding, and attitudes of nurses become important determinants of the quality of care that the elderly receives. Only a attitudinal change in nurses can make the transition of the concept of person-centered care to one of relationship-centered care with a deserved smoothness. Reference List Berry, AM., Davidson, PM., Masters, J., and Rolls, K., (2007). Systematic Literature Review of Oral Hygiene Practices for Intensive Care Patients Receiving Mechanical Ventilation. Am. J. Crit. Care; 16: 552 - 562. Bruce, ML., Have, TRT., Reynolds, III, CF., Katz, II., Schulberg, HC., Mulsant, BH., Brown, GK., McAvay, GJ., Pearson, JL., and Alexopoulos, GS., (2004). Reducing Suicidal Ideation and Depressive Symptoms in Depressed Older Primary Care Patients: A Randomized Controlled Trial. JAMA; 291: 1081 - 1091. 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