Challenges Facing Nurses in a Provision for Older Adults in Australia - Article Example

Contemporary Challenges Facing Nurses in the Provision for Older Adults in Australia INTRODUCTION Fragmented systems, inadequacies in access to health insurance and treatment, medical errors, waste and inefficiencies in the delivery and utilisation of medical care are identified as factors that contribute to the health care system’s disproportionate rates of negative experiences and poor quality outcomes among occurring among elder patients. Gray and Heinsch (2009) point out that the biggest challenge facing Australia is care, specifically, the labour shortages in the care industry and the high demand for quality care, which exceeds the supply. Practically, the documented problems of patient safety, disparities in health care and poor health status reveal that elder patients are not receiving the health care they need for improving health (Epstein et al, 2005). These findings suggest that the care patients and their families receive in health care organizations is often inappropriate, inadequate and fails to meet their specific needs. These findings identify a concern that the care delivery system has moved away from a patient-centred model of care towards one that focuses increasingly less on the patient and more on the needs of the system. The reality that health care organisations in Australia are not always delivering health care to elder patients and their families that emphasises their individual needs, desires and circumstances represents contemporary challenge for healthcare professionals and nursing personnel. The health care delivery method known as “patient-centred care” is now recognised as the mechanism most likely to improve quality of care and the health status of elder patients. This quality focus on the delivery of patient-centred care recognises the contribution of patient and family experiences in care delivery processes (Epstein et al, 2005). This approach includes an appreciation of interpersonal processes or the relationship development aspects of care as essential and pivotal requirements for the delivery of high quality health care. This particular “patient-centred” perspective for care delivery has become the leading policy directive for improving quality (Davis, Schoenbaum & Audet, 2005). At the point of service and service delivery, nurses are uniquely positioned to deliver patient-centred care for Australia ageing population. Although no single definition of patient-centred care is commonly acknowledged, typical dimensions of patient-centred care include health care activities that encompass the qualities of caring, compassion, and responsiveness to the needs of the individual human (Healthissuescentre, 2010). Effective patient-centred care has been shown to be influenced by organisational factors such as characteristics of the work environment and nurses’ job satisfaction. In studies comparing patient-centred care delivery with organisational variables of job satisfaction and work environment, nurses perceived their ability to deliver patient-centred care as improved with increased job satisfaction and a quality work environment. (McCauley & Irwin, 2006). This paper aims to discuss one of the most pressing contemporary challenges for Australian nurses – ongoing need for patient-centred care for elder patients. PROFESSIONAL PARADIGM OF CARING. Current professional nursing standards value the patient as the centre of care; nursing is separated from medicine and other disciplines as nursing treats patients’ responses to illness. Early nursing theorists have defined the needs of the individual patient as a professional commitment of the nurse, while contemporary studies define patient-centred nursing in the context of individualised care. Carter et al (2008) explored nurse caring in their mixed methods study involving the use of surveys and focus groups. Nursing staff (n=31) and patients (n=62) were both surveyed, with nurses alone providing the focus group data. The aim of the study was to “explore the state of patient-centered care on a medical unit as perceived by nursing staff and patients using Watson’s Theory of Human Caring as a framework” (Carter et al., 2008, p. 57). This study was prompted by concerns over the impact of technology and associated tasks on meeting patients’ needs for care. They hypothesised that the new technology would detract from caring for patients. Findings identified patient-centered caring as part of quality care; however, patient-centred care was influenced by organisational factors, “key elements of the patient-centred caring environment included teamwork, personal support from peers...physical environment and workload” (Carter et al., 2008, p. 61). From the critical perspective, little research is available that actually addresses factors influencing implementation of effective patient-centred care. From the previous studies examined, organisational factors are unmistakably identified as central to the implementation of quality care. Study conducted in Commonwealth countries by West, Barron and Reeves (2005) had as its aim identifying barriers to the delivery of patient-centred care and a focus on how the lack of required resources such as time, tools and training influenced nurses’ ability to do their job (p.435). In this study, over 64% of the nurses who participated said they had “too much to do” in order to deliver high-quality care (West et al., 2005, p. 435). In the West et al. (2005) study, “Results clearly show that nurses are aware that they are unable to meet patients’ needs in some areas, particularly their needs for emotional support, appropriate treatment for their symptoms and conditions, and effective discharge planning (p. 442). While it is unjustifiable to generalise the results of the West study to health care delivery in Australia only, similar concerns may exist. FRAMING PATIENT-CENTRED CARE FOR ELDER PATIENTS A variety of descriptions for the concept patient-centred care are identified in the literature. Definitions for patient-centered care for elder patients range from simple descriptions to elaborate multidimensional frameworks. One such simple definition recognises patient-centred care as understanding the patient as a unique human being (Davis et al, 2008). According to Davis et al (2008), the term “person-centred” reflects the fundamental notion of the person being the focal point in a partnership that is both respectful and reciprocal (p.496). Another more elaborate definitions considers total of 8 dimensions of patient-centred care, including: 1) respect for the patient’s values, preferences, and expressed needs; 2) information and education; 3) access to care; 4) emotional support to relieve fear and anxiety; 5) involvement of family and friends; 6) continuity and secure transition between health care settings; 7) physical comfort; and 8) coordination of care. In order to achieve these objectives Cohen-Mansfield et al (2006) point out that caregivers have to adapt schedules, decisionmaking processes, and environments to the needs of the patients thus requiring a great degree of flexibility. Therefore, another dimension of patient-centred care is flexibility, “an important ingredient, not only in the care process of residents, but also in the administration of staff members in nursing homes” (Cohen-Mansfield et al, 2006, p.540). A recent dimensional analysis of patient-centered care has helped to identify how inconsistent the phenomenon is conceptualised throughout the clinical and research literature (Hobbs, 2009). Most definitions of the concept patient-centred care for elder patients are derived from the patient centred clinical method. Current conceptualisations of patient-centred care are consistent with the specific elements or communication strategies used most often to engage elder patients in a therapeutic relationship. Examples of these dimensions include essentials such as therapeutic decision-making, exploring patient’s ideas and feelings, recognition of patient’s expectations and perceptions of the impact of their illness and doctor-patient interactions (Taynor et al, 2005). This recognition for patient-centered care suggests that it might be defined as the processes of care that evokes the therapeutic relationship. According to Joms et al (2009), considerable evidence indicates that interventions designed to inform, educate and involve patients in their health care are effective, improving experiences, clinical outcomes and resource utilisation. In Australian context, Hung the Nguyen (2009) links patient-centred care to cultural safety, awareness and competence, indicating that as a concept, it enhances the professional and ethical role of health practitioners” (p.990). Although patient-centered care is often considered the most recognised terminology for care delivered to patients with their vested interests in mind, a variety of other phrases connote similar meaning. Relationship centred care builds on the foundations of the patient centred model in that it not only promotes a whole person approach but expands beyond the patient to include the reciprocal interactions of the individuals, the community and interdisciplinary aspects of health care. The most recently recognised term to grace the patient-centred care literature is patient-centred care. This new perspective broadens the scope of patient focused care delivery for elder patients to include family members as essential to the patients’ overall health and wellbeing (Conway, et al, 2006). REFERENCES Carter, L.C., Nelson, J.L., Sievers, B.A., Dukek, S.L., Pipe, T.B., & Holland, D.E. (2008). Exploring a culture of caring. Nursing Administration Quarterly, 32(1), 57-63. Conway, J., Johnson, B., Edgman-Levitan, S., Schlucter, J., Ford, D., Sodomka, P. & Simmons, L. (2006). Partnering with patients and families to design a patient- and family-centered care health care system: A roadmap for the future. Robert Wood Johnson Foundation: Working paper. Retrieved from September 10, 2010 Davis, K., Schoenbaum, S.C., & Audet, A.M. (2005). A 2020 vision of patient-centered primary care. Journal of General Internal Medicine, 20(10), 953-957. Sandra Davis, Suzanne Byers, Fay Walsh. (2008). Measuring person-centred care in a sub acute health care setting, Australian Health Review. Sydney, 32 (3): 496-505 Epstein, R.M., Franks, P., Fiscella, K., Shields, C.G., Meldrum, S.C., Kravitz, R.L., & Duberstein, P.K. (2005). Measuring patient-centered communication in patientphysician consultations: Theoretical and practical issues. Social Science & Medicine, 61, 1516-1528. Mel Gray, Milena Heinsch (2009). Ageing in Australia and the Increased Need for Care, Ageing International, 34:102-118 Hobbs, J.L. (2009). A dimensional analysis of patient-centered care. Nursing Research, 58(1), 52-62. Hung The Nguyen. (2009). Patient centred care: Cultural safety in indigenous health, Australian Family Physician. Melbourne: Dec, 37 (12): 990-995 Jiska Cohen-Mansfield, Allan Bester. (2006). Flexibility as a Management Principle in Dementia Care: The Adards Example. The Gerontologist. Washington: Aug, 46(4): 540-545 Christine M Jorm, Nicola Dunbar, Leena Sudano, Joanne F Travaglia. (2009). Should patient safety be more patient centred? Australian Health Review. Sydney: Aug, 33 (3): 390-399 McCauley, K., & Irwin, R.S. (2006). Changing the work environment in intensive care units to achieve patient-focused care: The time has come. American Journal of Critical Care, 15, 541-548. Victoria Traynor, Susan Brisco, Tina Coventry. (2005). Developing person-centred dementia care in acute settings: findings from a study tour in Australia. Nursing Older People. Ely: Nov. 17(8), 16- 20 West, E., Barron, D., & Reeves, R. (2005). Overcoming barriers to patient-centered care: time, tools and training. Journal of Clinical Nursing, 14, 435-443. Read More