Acute care and older people challenges and ways forward

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Scholarly PAPER, INTRODUCTION have an increased risk of post surgery complications. episodes of acute confusion during hospitalisation. This paper draws on contemporary evidence,and so called challenging behaviours which. regarding the challenges for older people in acute. are manifested through expressions of anxiety,care hospitals and the concept of person centred. hallucinations and delusions aggression and,care to a suggest ways in which acute hospital. agitation wandering restlessness rummaging and,environments might be modified to better meet the.
other socially deviant behaviors Miller 1999 Finkel et. needs of the older person and b question whether, al 1996 In acute care hospital settings behavioural. options other than acute care should be canvassed,changes can emerge from a combined stress of. for older people,illness and being in an unfamiliar and confusing. BACKGROUND environment and are not necessarily symptoms of. dementia These behaviours are unfortunately too,Older people are admitted to acute hospitals more. often managed through the provision of psychotropic. commonly and have longer lengths of stay than,medication the use of physical restraint and.
younger persons Nay and Garratt 2004 While,or the engagement of specially assigned patient. people aged over 65 constituted 12 1 of the,attendants Werner et al 2002 Besides the obvious. Australian population they accounted for 48 of, personal suffering for the person and family afflicted. all hospital days in 2001 During the same year the. by such behaviours these are also associated,mean length of stay for a female patient between. with poor outcomes during hospitalisation with,40 45 years was 2 8 days as compared with 10 9.
increased length of stay mortality post hospital,days for a female patient above 85 years AIHW. institutionalisation and escalating health care costs. 2002 Not only are older people larger consumers,Schofield and Dewing 2002. of health care there is also ample evidence that, older people admitted to general acute hospital In light of knowledge that the overall wellbeing of older. care face considerable physical and psychological people is often adversely affected by experiencing. stressors and are at an increased risk of adverse the hospital environment we argue there is a need. events psychological and behavioural symptoms to increasingly apply person centred perspectives in. general deconditioning falls loss of mobility and acute hospitals Person centred care has emerged as. functional decline Nay and Garratt 2004 Cassidy a contemporary gold standard model receiving much. 2001 In addition as many as 33 66 of older attention within sub acute and residential aged care. people receiving hospital care are estimated to suffer for older people McCormack 2004 Kitwood 1997. from cognitive impairment Dewing 2001 Tolson et Person centred care was developed as a response. al 1999 and this poses additional challenges for to the bio medical view of disease which was said. hospitals as people with dementia have increased to downgrade the person to being merely a carrier. needs to experience safety calmness and familiarity of disease or a malfunctioning organ McCormack. in their environments Zingmark et al 2002 2004 Even though the concept person centred. care lacks a clear consensus definition Edvardsson. The hospitalisation of older people can often, et al 2008 it is generally described as collecting. exacerbate distress and dysfunctional behaviours,and using personal information in care taking a.
Miller 1999 Stressors that negatively affect older. bio psychosocial perspective and seeing the patient. people and persons with cognitive impairment,as a person Edvardsson et al 2008 Slater 2006. include changes in routine environment or caregiver. Furthermore offering and respecting patient choices. but also facing demands that exceed functional, using the person s past life and history in care and. capacity through multiple and competing stimuli, focusing on what the person can do rather than the. and or having pain or negative reactions to, abilities that have been lost due to the disease is. medications It has also been shown that older people. AUSTRALIAN JOURNAL OF ADVANCED NURSING Volume 27 Number 2 64. Scholarly PAPER, central to a person centred care approach Brooker Perspective three Ronnie 52 years old Emmy s.
2007 McCormack 2003 However the concept son, has been criticised for being a political slogan or. My name is Ronnie I am Emmy s son I have,evangelical ideal Packer 2000 often quoted but. told them and told them to call me if Mum has a, ill defined Nolan et al 2004 and used synonymously. problem now I get here and find her all bruised and. with good quality care even though this remains to. bleeding She is never angry at home but they rush,be supported by evidence McCormack 2004. her and don t listen She is very dignified and would. A fictitious but not unusual event of a busy acute be mortified to wet the bed but they don t seem to. hospital ward is described below from three care Is this what quality care is all about. perspectives to illuminate how the same series of, events can be interpreted very differently by the DISCUSSION.
nurse the older patient and a family member Applying person centred care in acute care settings. and is also presented to provoke reflection on how eight dimensions for discussion. person centred care can be used to address some Adopting person centred approach to care for. of the issues emerging in the event older people in acute settings begins with trying to. Perspective one Karen 33 years old registered establish a philosophy of care that puts the older. nurse at Ward X person s experiences at centre stage This can then. be merged with gold standard clinical guidelines and. We have been extremely busy the registrar has,best practice approaches to the assessment and. been up all night the phones have not stopped,maintenance of health among older people in acute. ringing two nurses have rung in sick and the ward, hospital settings Nay and Garratt 2004 The following. is crowded One of the older patients Emmy started, aspects have been extracted from the literature as. to wander about became aggressive verbally,making up the cornerstones of person centred care.
abusive impossible to shower and was constantly, for older people and are presented to illustrate how. trying to get out of bed all night We simply had no. acute hospitals can better meet the needs of older. option but to restrain her to stop her hurting herself. people and family members, However she nearly strangled herself in the rails so. we sedated her and removed the restraints When 1 Establishing a philosophy of care that is. she woke up she fell over the end of the bed and person centred and holistic. now has a major bump on her head The family is The establishment and use of a philosophy of care. furious and said we should have called them earlier that states the fundamental assumptions goals. but we just didn t have time Person centred care and care strategies of the institution has been. who has time for that shown to assist health care staff in making care. decisions and communicating to patients and,Perspective two Emmy 86 years old patient in. patients have described how they appreciated,explicit care philosophies as they appeared to. My name is Emmy I am a holocaust survivor and I unite staff towards a shared goal Edvardsson et. have awful pain I don t recognise anything or anyone al 2005 A holistic person centred care philosophy. in this dreadful place Everyone is on the run and means placing the patient with his her needs. there are loud noises everywhere I do know that if and wishes in the centre of care collecting and. you go to the shower you don t come back I need to respecting patient choices and giving relationships. pass water but they have tied me down and I can t and tasks equal importance McCormack and. get to the lavatory They say the doctor is coming McCance 2006 As emerging in the example of. but I ve heard they do awful experiments so I must the nurse at ward x the concept of person centred. try to escape care needs to be operationalised and integrated. AUSTRALIAN JOURNAL OF ADVANCED NURSING Volume 27 Number 2 65. Scholarly PAPER, into daily practice so that it does not feel like reading the paper or helping out with serving lunch.
another burden adding to staff stress Those are small but important things that can be. provided even in a busy acute care environment,2 Developing care systems that support. and can help to maintain a sense of self in the,person centred care. older patient Edvardsson et al 2005,Care needs to be organised in a way that. promotes shared interdisciplinary assessment 5 Adapting environments to assist comprehension. communication and treatment in a teamwork rather than confusion. fashion Developing systems to secure valid The acute hospital environment can also be. reliable and comprehensive data collection about adapted to promote independence in finding. symptoms as well as life histories for development different places such as the bathroom the bed. of individualised intervention strategies and space the dining space or other place The. systematic outcome measurements are important environment should enhance rather than obstruct. Such would preferably include all relevant aspects patient independence Consider keeping corridors. that might influence the person s well being free from institutional clutter symbols indicating. which obviously involves drawing on the expertise the function of rooms clear signage and other. of family landmarks such as changes in colours paintings. or other symbols have been shown beneficial for,3 Collecting personal history of patients. orientation Day et al 2000 Conscientious use of,Collecting and disseminating information.
colour and creating effective colour contrast in the. regarding who the person is can inform appropriate. environment can together with good lighting aid,person centred care by supporting staff to see. the older person to move about more confidently,the person behind the disease Knowledge of. Wijk 2001 If Emmy s personal history and needs, significant life events interests likes and dislikes. had been known the environment could then have,can help to maintain and enhance a sense of self. been adapted to better fit her needs of calmness,in older people whose world has been altered by.
staff presence and consolation,the sudden onset of disease Penrod et al 2007. Brooker 2004 In the case of Emmy collecting 6 Developing care plans with emphasis on. such a personal history could have contributed to strengths rather than problems. interpreting her behaviours as adequate reactions Care plans need to be developed directly with. in light of her history as a holocaust survivor and the older person by the interdisciplinary team. thus other care strategies aside of sedating her and in cooperation with family The care plan. might have been chosen should emphasise the older person s strengths. and remaining abilities rather than focus on,4 Establishing a trusting relationship. deficits and problems The concept of informed,Person centred care also entails giving attention. flexibility defined as facilitating decision making. and value to establishing relationships in addition. through sharing of information and integrating new. to completing tasks Establishing a relationship,information into care practices and perspectives. facilitates feelings of being seen and cared for or in. is one central constituent of person centred care, the case of task orientation neglected and treated.
Edvardsson et al 2008 In the case of Ronnie he,like an object In acute care patients and family. could share valuable information about Emmy with,have generally no competence to evaluate the. staff to integrate in daily practice Also taking part. medical procedures but they can all evaluate the, in planning for Emmy s stay might have facilitated. way in which they are encountered Also making,a mutual understanding between him and the staff. space for meaningful activities can be of immense,in addition to benefiting Emmy s care.
value This can include basic activities such as, AUSTRALIAN JOURNAL OF ADVANCED NURSING Volume 27 Number 2 66. Scholarly PAPER, 7 Offering a calm pace and optimal stimulation CONCLUSIONS AND RECOMMENDATIONS. The combination of a busy acute hospital setting,It is not our intent to slant any blame towards. and a lowered stress threshold in the older, physicians or nurses in the acute hospital settings. person Hall and Buckwalter 1987 can create,as we are well aware that most health care staff.
experiences of haste chaos and disorganisation, try their best to solve the equation of strict time. for the older person as it did for Emmy It might,constraints and increased work loads However. not be surprising to find reactions such as anxiety. available evidence indicates that we can do better for. agitation and restlessness in the older person as a. older people in acute care Acute hospitals are fit for. response to sensory overload A slower pace of care. purpose which is to respond to acute emergencies,and carers and reduced noise from telephones. AUSTRALIAN JOURNAL OF ADVANCED NURSING Volume 27 Number 2 63 SCHOLARLY PAPER AUTHORS David Edvardsson RN PhD Assistant Professor Department of Nursing Umea

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