Nursing assignment on: Care in nursing home

1) a)      What is the difference between a hostel and a nursing home?

Nursing homes are places were complete care and high end care is provided by the registered nurses and occupational therapists, for example meals, dressing, laundry and treatment.  Whereas the hostels are the places were low end care is given and residents have to take their own care however few recreational facilities are provided.

b)      Differentiate between low care and high care needs and identify the classifications of clients you might find in each.

The care provided to individuals, who need assistance in taking care of themselves although they are independent from most of the aspects is known as low care which is generally provided in the hostels. The high care provided in nursing homes is the complete care to individuals who are incapable in taking care of themselves.

c)       Describe the type of care assistance given in each type of care.

In hostels, low care is provided which includes accommodation and food is provided along with some recreational facilities for refreshment and entertainment and to create a home like environment. A short term respite service is also provided when and if required.

In Nursing homes, high care is provided which includes complete care taken by registered nurses and the occupational therapists. 24 hour nursing care is provided along with all medical facilities. Laundry, dressing and treatment is also part of the high care provided in nursing homes.

d)      Is “respite” offered in either type of care?

Respite is the care where individual remains at home with a carer. Respite care is provided sometime in hostels also when hostel residents suffer from extreme illness or injury.

2) The changing demography of ageing population in Australia greatly affects the nursing care.  With more number of ageing people the demand of the nursing care will also increase, language, culture and economic status plays very important role in the procedure of nursing care as in nursing care the most essential component is the communication between the client and the care provider, if the care provider is unable to communicate properly the essentials of nursing care to the client in his or her language then it might severely affect the nursing care procedures resulting into its failure.

3) The successful physical aging is defined as progressing towards age but not experiencing the normal aging difficulties by healthy practice, and successful social ageing is adapting to the new climate and new generation so that you wont feel isolated. Ageing is a procedure which takes the fastness from individual, so it has to be dealt with patience. I will discuss issues such as coping with day to day life activities, how to combat self care deficit problems, how to manage personal hygiene, how to keep the memory  in better shape and what are the healthy eating habits that can lead to both social and physical successful ageing.

4) The nursing interventions are as follows-

Assessment of the degree of neurological impaired ness – rationale- this helps in applying proper interventions and to design proper care plan of the patient.

Assessment of neurological function affected such as in legs, hands and other parts providing physiotherapy from a guided physiotherapist- rationale- improvise the blood circulation and helps in regaining the neurological power .

Assess the cause of the neurological disorder and try to cease the factors affecting the neurological function- it helps in improving the neurological function, such as restricting arthritis patient from more water based works helps in reducing the condition as well as improves the neurological function.

Teaching the client how to cope with those difficulties- This helps in patient to overcome the self deficit problems. (Kirton et al, 2012).

5) The best recommendations are using of absorbent body worn pads which were light that can provide safety and independence to the clients, proper implementation of toilet regimes so that before incontinence starts patients empty the bladder, catheters can be applied in case of persistent incontinence, sheaths can be used by the male patients. (Beck et al, 2005).

6) The Norton scale was developed in UK and has five components such as mental condition, physical condition, mobility, activity and physical incontinence. The scores of risk range from 5 – 20. But in water low the risk assessment is a simplistic tool. While one side of it shows how the risk should be minimized, the other side shows the type of risks etc. Much efficient than Norton scale.

7) Polypharmacy is defined as the administration of more than five or four medications to a patient. It has significant risk to the elderly clients such as-

Impairment in metabolic activities

Heavy side effects such as gastric, nausea, vomiting etc

Neurological disorders and gastroenterology disorders (Patterson et al, 2012)

8) While acute pain start suddenly implicating there is an onset of any disease, but chronic pain is like persistent pain which is experienced even though the pain or injury has been healed. The duration of the acute pain is less, which is they may be experienced for a week, a day or a month. But the chronic pain can be experienced for years. The acute pain is mostly caused by the surgery, labor pain, dental works, bone breaking etc while the chronic pain can caused by any type of ailments which are reoccurring in nature. (Mehta et al , 2010)

The other types of pain experienced by the older people are mental pain due to any type of psychological abuse, widespread pain where pain doesn’t limit itself to a particular part of the body.

Older people can be helped in explaining their pains by – talking with them with a palliative approach. Making them easy and comfortable. Asking questions such as where is the pain? Hoe much is the intensity? These questions should be asked in an interactive manner by asking them to show the parts. Asking questions like when pain starts and what they do in that time which makes them feels better? These questions helps the elder person to answer and explain the pain .

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10) Sleep assessment tool- This tool helps us to know whether we are getting a healthy sound sleep or not, or are there any sleep disturbances or sleep disorders or not. This will be applied by doing a short question answer section; by ticking right if we are experiencing that or ticking cross if we are not.

a) Snoring during sleeping.

b) Gasping of breath or shortness of breath during sleeping.

c) Dozing of or feeling sleepy during any activities such as watching TV, in class room etc, doing official work.

d) Having difficulty in sleeping three day per weeks due to any type of disturbances.

e) Feeling of any type of unpleasant senses such as creepiness, tingling sensation in feet

f) Interruptions to a good sleep such as bad dreams, unnecessary thoughts, heart burn, discomfort, pain etc. (Certal et al, 2012)

11) The four components of the self care are – Self care, self care agency, Therapeutic self care demand, Self care requisites.

The four nursing interventions that can be applied in the condition of self care deficit are – Acting and doing things for others , secondly in case of guidance  the patient or client can be guided how to carry out the works, Raising environment or developing environment that helps in the personal development of the person to meet the future requirements, supporting and teaching of the patients and clients helps to prevent the self care deficit problem. (Easton, 1993).

12) The three type f restraints are

Physical- Any instrument applied mechanically to restrict the patient movement.

Chemical- Administration of sedatives and psychotropic medication which is aimed for restraining the patient.

Environmental seclusion- That is restricting or closing an exit where there is chance of exit for the person.

b) Belts and cuffs are used to restrict the person movement on the bed and chair itself. Chair with tray, raised bed rails are some of the physical restraints that can be applied.

The uses of sedatives or medications that cause dozing in patients are another form of restraints mostly given when patients were not in position of taking any medication.

Seclusion from others, isolated in a single room with limited instruments but the doors always remain closed until and unless authorized by the doctor or care taker.

c) Effective communication with the patient with care can help in not using the restraint.

The nurses who were taking care of the patient must be trained to understand the non verbal communications of the patient, which in most cases give rise to violence tendency leading to restraint application.

The preventive measures such as proper intervention from starting should be done, and the environment should be maintained according to patient desire which will keep the patient or person in calm and supportive state.

13 a) there are five types of elder abuse. They are –

Physical – When physical strain or stress is given that cause physical impairment, injury, or pain it is called as physical abuse. Example- Forcefully feeding the elders the food which they do not want, not with an aim of protecting their health rather with an aim of time saving and money saving.

Sexual abuse- When any types of sexual relations natural or unnatural is kept with an elderly person without his/her consent it is called as sexual abuse. Example- Touching of genitals and other private parts of an elderly woman during treatment or simply during the care.

Physiological/Emotional abuse- Imposing or expressing the anger, stress upon the elderly people through verbal or non verbal means. Example- Isolating elderly people in a social gathering, or insulting them through actions during a party.

Financial Abuse- When the funds, assets or property of elders is taken forcefully or with tricks, then this type of abuse is called as financial abuse.

Neglect- When someone in charge of care of an elderly person, intentionally fails to deliver the required amount of care needed then it is called as an act of neglect. Example- Not providing proper medicines in time to an elderly patient. (Crinner, 1994)

Risk factors for elder Abuse

Like other types of disturbances and abuses, elder abuse is also complex. Risk factors rise from the socioeconomic, psychological, mental and physical status of the victim and the doer. It is not possible to list the exact risk factors associated with elder abuse since they are diverse in origin, but there are certain which are related to the risk factors

Old domestic violence- When any one partner try to impose certain things by force in any means from starting, it leads to complex situations in future giving it a form of elder abuse.

Dependence of adult children- At times adult children due to their own personal problems abuse the elder ones to get financial support, to get mental support or due to excessive stress they may abuse.

Living with isolation- When elder are left to live alone they are abused by the abusers, so that the person who abuse want that they should not be allowed to mix with others since this will lead to the discovery of the abuse incident.

Stress of the caregiver- At times the care giver who is offering care due to the burden of the care may end up with negligence and abuse of the elder.

Personal character of the victim- Some time the personal character of the victim also give rise to abuse. Such as some of the male mental patient may seek sexual preference leading to the physical abuse.

Signs of elder abuse

Since the signs of elder abuse are many, but here we will mention some of them.

Any type of the physical injury found on the body shows the sign of elder abuse.

Any type of impairment, injury in or around the groin or genital or anal area is a symbol of sexual abuse.

Sudden change in the behavior, withdrawn from the normal social life, agitation is symptoms of emotional abuse.

Malnutrition, dehydration, bed sores, unhygienic clothes and other health ailments which can be cured by little caring are symptoms of the neglect

When the elder feel deserted at home, or hospital or shopping complex it indicates a financial abuse.

Ethical and Legal Duties of EEN in Elderly abuse case

The first legal duty when any incidence of abuse comes into existence is, to report to the legal cell of the hospital, or citizen advocacy group, or hotlines for elderly abuse in any nursing homes. Even though at time ethical dilemma will rise but protecting one’s life is above all ethics.

The ethical duties include try to know the exact cause of abuse and try to coordinate between the law enforcing group and other groups.

Improvisation of the work conditions, such as giving adequate staff, improved communication between the victim and the nurse, time to time reporting of the situation to administration department etc.

Supporting the nurse’s aides in case of any force abuse rose due to the erratic behavior of the victim. (Venturato et al, 2007).

14) In most of the community care, the subsidized fees are given by the government of Australia. Even though people are also expected to pay certain amount for their care, but upon request that they can’t be able to pay the government pay the total amount so that no aged person is denied a care. Different type’s of pension also exists such as community package pension for dementia, for aged care which can be availed by the aged persons. In local circle the government at local level provides package depending upon the income and daily costs of the person. So basically the funding is from the government of Australia. (Lewin et al, 2011)

15) ACAT is a team which has been built to assess the care which were provided by the hospital and aged care home to elder people, and check their compliance with government guidelines and ethical guidelines. The main role is to assess the psychological and physical status of a person, to know to which type of retirement village he or she is eligible.

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