Introduction
Mrs. Blackwell represents many aged individuals in Australia and worldwide who need comprehensive and long-term care strategies to cope with their situation due to advanced age (Borowski, Encel, and Ozanne, 2007, p.20). Developing a comprehensive and long-term care strategy for aged individuals like Mrs. Blackwell requires an adequate nursing diagnosis of the conditions and situation of the individual.
Conducting a nursing diagnosis of Mrs. Blackwell, three conditions are identified that subsequently require interventional strategies. Mrs. Blackwell exhibits impaired mobility and increased bowel irregularities, which can be linked to total hip arthroplasty, leading to an experience of difficulty in using a walking frame. Secondly, Mrs. Blackwell exhibits increased potential risk of falls that are related to previous falls, difficulty using a walking frame, and an overall expressed fear of falling. Lastly, diagnosis reveals that Mrs. Blackwell exhibits potential for adverse drug reactions and this is related to polypharmacy and infrequent visits to GP.
Objectives for long-term care strategy for aged people in society emanate from two frameworks developed earlier; ADLs (assistance with basic activities of daily living) and IADLs (instrumental activities of daily living) that when implemented, is likely to see an improved situation for aged people (Balducci, Ershler and Gaetano 2008, p.26). ADL’s goals involve among other aspects, bathing, dressing, eating, and other basic chores, while IADL’s goals revolve around providing assistance with household chores, money management, shopping, medication management, and other activities (Balducci, Ershler, and Gaetano, 2008). Therefore, the subsequent sections will largely look at the nursing interventions originating from the identified nursing diagnosis and rationale behind each of the adopted or suggested interventions. Lastly, there will be a short discussion on how nurses’ attitudes to older people affect the quality of care they receive.
Intervention Strategy
Diagnosis One
The overall goal is to achieve relatively reduced instances of impaired mobility, injuries, and increase the functionality of the bowel system. To achieve this goal, three interventional strategies are proposed. The majority of elderly people experience impaired physical mobility that leads to increased falls, and this aspect increases as older people continue to advance in age (Brunner et al. 2009). Among elderly people aged above 85 years like Mrs. Blackwell, falling incidences are higher and the outcomes of falls become even worse.
Intervention one
Bowel irregularities that Mrs. Blackwell exhibits have contributed to her frequent mobility problems. However, falls can be managed through the administration of the right dietary intervention (Hindle and Coates, 2011). Majority of elderly people who exhibit higher chances of experiencing mobility problems lack the right diet. Chances are that her problem has been largely motivated by a lack of vitamin B1 and B12. Lack of vitamins B1 and B12 in the diet is associated with the development of bowel problems, light-headedness, and sometimes confusion (Hindle and Coates, 2011). The rationale for this intervention lies in the role diet plays in contributing to the strengthening of fragile bones and joints, which vitamins B1 and 12 are known to provide. Further, a good diet will lead to improvement of vision, mental, and overall steadiness which is vital for Mrs. Blackwell (Hindle and Coates 2011).
Intervention two
Light exercise intervention constitutes the second set of prevention and management strategies. Mrs. Blackwell requires light exercises. Many elderly people abandon exercise as their health deteriorates, and this leads to clogging of blood veins, making it difficult for blood supply to take place (Hindle and Coates 2011). When this happens, an individual’s physical joints become weak and fragile, constantly leading to impaired mobility. Introduction of simple feet exercises that include raising the heels, stretching, ankle rotating, moving, squeezing, and also opening and curling toes should be largely encouraged and elderly people helped to perform them (Hindle and Coates, 2011). The exercises should take place at least every day and in undertaking the exercises, the elderly should be encouraged not to have shoes on or to wear socks to enable greater flexibility (Hindle and Coates, 2011). Moreover, these exercises can be done while the elderly patient is sitting down; hence, standing is not necessary. The rationale for this intervention is premised on the fact that exercises have been found to be ideal prevention strategies for mobility problems among elderly people and people with medical conditions that limit their movement (Hindle and Coates, 2011).
Intervention three
The third intervention strategy involves foot care management. Older individuals who complain of mobility problems and increased fall instances lack effective foot care management (Hindle and Coates, 2011). Mrs. Blackwell should be encouraged to take great care of her feet, and this will involve washing regularly and drying them thoroughly. After they have been cleaned, the feet should be applied with moisturizing cream to keep the skin supple. In most cases, unsafe footwear causes falls and therefore, elderly people are encouraged to wear supportive, low-heeled, and non-slip sole shoes (Hindle and Coates, 2011). The shoes should enable an elderly person to wriggle her toes while snugly fitting around the heel. The rationale for this interventional strategy is informed by the fact that increased falls among elderly people are associated with poor foot care, which subsequently limits elderly movement (Hindle and Coates, 2011).
Diagnosis Two
The overall goal is to achieve a considerable reduction of fall risks and increase patient confidence with regard to mobility. To achieve the objective, three interventional strategies are proposed. Mrs. Blackwell exhibits increased potentials for risk of falls that are related to previous falls, difficulty in using a walking frame, and an overall expressed fear of falling.
Interventional one
Environmental modification constitutes the first interventional strategy for this condition. Elderly individuals tend to exhibit reduced confidence about their ability to move without falling. This fear emanates from the presence of the poor home environment in which the elderly person lives. Interventional measures to be undertaken here include increasing the surrounding illumination of steps and stairs to ensure proper and safe foot support and balance, as well as increasing bathroom grab bars to help reduce the fear associated with toileting and bathing activities (Tideiksaar, 1997). Other measures include eliminating mobility obstacle elements such as trailing flexes, loose rugs, loose carpets, slippery flooring, and many more, which may cause fall; thoroughly wiping spillages; furniture equipment to be easy to reach especially those involving bending; sockets to be located at an appropriate height level; and generally, increasing heating and warmth in the house (Hindle and Coates, 2011).
The rationale for this intervention strategy is premised on the role inappropriate home and institutional environments have played in accelerating the level of fear among elderly people. Improving the home environment has been found to result in decreased falling phobia, with a level of confidence in mobility activities among the elderly increasing (Hindle and Coates 2011).
Intervention two
The second proposed strategy to deal with increased fear of falling includes development, introduction, and promotion of habituation therapy activities (Tideiksaar, 1997). In most cases, older people express great fear with regard to activities such as bathing, toileting, climbing stairs, walking outdoors and even walking in the streets. Habituation therapy can be developed based on two prominent scales; “Falls Efficacy Scale (FES)” and the “Activities-Specific Balance Confidence Scale (ABC)” that have been found to be effective (Tideiksaar, 1997). Habits to develop among fearful elderly patients’ include guided walks up and down the stairs inside the house, bending over, and picking few items on the floor, and slight and guided walks outside the house to a car parked in the driveway (Tideiksaar 1997). Other habits to encourage include getting in and out of the chair, standing on a chair and picking objects slightly above, light housekeeping, simple shopping, and taking showers (Tideiksaar 1997). Rationale for this intervention can be exhibited in the fact that confidence among elderly people having mobility problems has been found to increase when habitual activities that result into fear are encouraged and practiced continuously (Tideiksaar, 1997).
Intervention three
The third intervention strategy involves promotion of balance and muscle-strengthening exercises. People with increased fear of falling need to participate in some coordinated and guided balance and muscle-strengthening exercises, which have potential to increase and improve their mobility (Tideiksaar, 1997). In developing exercise plan, the focus should be put on enhancing muscular strength, joint flexibility, and sensory interaction. These kinds of exercises have been found to improve the gait and balance of older people (Tideiksaar, 1997). Further, weight-bearing exercises should be encouraged, since they have proved to reduce the rate of bone loss and reduce chances of fractures.
Rationale of this intervention lies in the fact that research has shown that people with increased fears resulting from impaired mobility perform better on neuromuscular test of functions due to exercises as compared to those who do not exercise (Baylor 1988 cited in Tideiksaar 1997).
Diagnosis Three
The overall goal is to achieve reduced levels of adverse drug reactions and increase visits to GP. In order to achieve this, three interventional strategies are proposed. Mrs. Blackwell exhibits potential for adverse drug reactions and this is related to polypharmacy and infrequent visits to GP. Intervention strategies with regard to this largely manifest in medical and rehabilitative strategies.
Intervention one
Doctor-monitored pharmacological intervention constitutes the first strategy to be adopted. Particular medication prescriptions have been associated with increased levels of falls and general mobility problems. For example, sedatives, antihypertensive, strong analgesics, and diuretics have been identified to cause side effects of unsteadiness, dizziness, confusion, sedation, and blurred vision (Hindle and Coates, 2011). As a result, there is need for a comprehensive medical review in the case of Mrs. Blackwell. GP intervention should be incorporated and Blackwell’s medical and medication opportunities discussed. Recommendations for medical withdrawal should be possible, especially where side effects are numerous and non-pharmacological interventions adopted. The rationale for this posit that majority of older people are under heavy and constant medication. The side effects are therefore likely to be numerous and as a result, doctor-monitored and coordinated intervention is likely to regulate medical administration, prescription, and effects among elderly people in the most appropriate way.
Intervention two
Older people are prone to medical conditions like depression, arthritis, cardiovascular, and many more, hence consumption of drugs is likely to increase (Tierney, McPhee, and Papadakis, 2006, p.49). As a result, there is need for establishment of patient home-based education program for Mrs. Blackwell (McKean, Bennett and Halasyamani, 2008, p.35). The essence of the program should be premised on the goals of educating patients with regard to medication, common side effects, and guidance on management of these side effects. Furthermore, home-based education program should encourage clear and useful communication between the elderly patient and home-based medical personnel. Communication should center on disease symptom indication, dose duration of each medication, and management of potential drug reaction symptoms (McKean, Bennett and Halasyamani, 2008). Rationale for this intervention emerges from the fact that, previous studies have indicated that effective educational training programs have led to positive management and improvement in mobility problems among elderly (McKean, Bennett and Halasyamani, 2008).
Intervention three
The third interventional strategy is to transfer Mrs. Blackwell to specialized institutional unit. Mrs. Blackwell lives alone at her house, with no any family or relative member at hand to help. Her condition requires timely care and specialized treatment, especially when her condition changes due to intake of drugs. In order to ensure close monitoring of her situation, frequent check-ups, and to reduce her infrequent visits to GP, it will be necessary to transfer her to a care institution that has enough specialized facilities as well as where medical attendance is fast and timely (Bernhardt 2008). Rationale for this strategy posits that majority of acute and post-acute elderly patients who have been admitted to specialized institutional units have manifested improvement in their condition after some period of time (Bernhardt, 2008).
Nurses’ attitude and quality of care to older persons
The attitudes of some nurses towards older people have been considered by many professionals in the health care field to influence the kind of care provided and the self-image of the older persons (Mallik, Hall and Howard, 2009). Matiti and Baillie (2011) observe that, nurses’ attitude influence subsequent behaviors and approaches that nurses adopt in administering care. Naden and Eriksson (2004) established that nurses who facilitate dignified care possess strong moral attitude that is in-built in values such as respect, honest and responsibility (cited in Matiti and Baillie, 2011, p.62). Such nurses exhibit passion and interest to help patients they care for. Dewing (2007) noted that nurse professionals usually transfer their personal values and beliefs to nursing profession in one way or the other (Mallik, Hall and Howard, 2009).
Kitwood and Bredin (1991) establish that, in order to improve older people’s quality of life, nurses need to develop principles of ‘personhood’, which should be applied throughout the care setting (cited in Adams, Clarke, and Royal College of Nursing, 1999). At the same time, nurses should establish professional contacts and networks that help them to continuously develop and grow their own care skills and knowledge. Subsequently, nurses working with older people should be in a position to develop deeper and more mutually supportive relationships with each other and the patients they are caring for. Mallik, Hall, and Howard (2009) observe that, it is important for nurse professionals to participate in active reflection in order to evaluate how their values and beliefs influence the health care profession. When working with older people, nurses usually find their held personal values and beliefs in conflict with those of patients, a situation that may affect the entire health care process or program.
Caring for elderly people should further involve the nurse developing and promoting aspects of compassion (Lundy and Janes, 2009). Given their situation, older people feel lonely, depressed, and stressed, which calls for greater expression of compassion to their intrinsic and extrinsic needs. Accordingly, compassion requires effective and genuine communication with the patient and always, the nurse must develop and exhibit aspects of flexibility, patience, and willingness to respond positively to the elderly patient (Lundy and Janes 2009). However, what is advisable is for nurses to utilize their values and beliefs as key tools of decision-making, care planning and care delivery (Mallik, Hall, and Howard, 2009). As a result, nurses are required to reflect on their values and beliefs about older people. Success in working with older people will emanate from nurses developing critical insight about older people, and this constitutes a critical skill that helps nurses to set personal standards required to work with older people.
Conclusion
The ageing population in Australia is estimated to be on an upward increase, a situation that posits that care for elderly people in the society is likely to continue in future. Nurses continue to play great role in the care of older people, although sometimes their attitude and values influence their overall administration of health care. Creating effective intervention programs for elderly people remains one of the critical duties nurses are involved in. Nevertheless, the process sometime may be challenging, given the compounding issues and problems affecting older patients. Found in this quagmire, nurses are advised to carry out thorough assessment of elderly patient care needs and identify the most appropriate intervention strategies. In the entire process, adopted intervention strategies should have capacity to give meaningful help and ensure health improvement of elderly patients.
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