Challenging Practice, Service Improvement and Contemporary Issues in Later Life - Essay Example

?Challenging Practice, Service Improvement and Contemporary Issues in Later Life: Explore strategies that nurses can adopt to challenge practice in relation to the care of older people. Introduction Older adults in healthcare go through various difficulties, not only in their health but in how they are managed as individuals in society and in the healthcare system. These older adults are usually prone to chronic diseases which often eventually confine them in hospitals for prolonged periods of time (Lubkin and Larsen, 2012). These diseases include diabetes, cancer, osteoarthritis, and similar other chronic illnesses (Lubkin and Larsen, 2012). Within the healthcare sector, the care of older adults is often filled with discriminatory practices, mostly in relation to the fact that they are no longer productive members of society and that their life expectancy is low (Katz, et.al., 2012). It is therefore common to witness the negative approaches that healthcare givers manifest towards older adults. The government through the Department of Health also believes that these patients are too old to engage in health promotion strategies (NMC, 2008). In general therefore, these older adults are often subjected to abuse in the health care system. Under these conditions, I have discovered the importance of reporting the abuse and neglect of these patients. This topic shall assess strategies that nurses can adopt in order to challenge practice in relation to the care of older people. I chose this topic because I want to increase my knowledge in effective ways, to challenge the practice and in turn, improve the services offered to these patients. Health inequalities include age discrimination, budget cuts for older adult care, neglect, as well as not being treated with dignity and respect (NMC, 2008). The Nursing and Midwifery Code (2008) specifies that older adults must not be discriminated against in their healthcare; instead, they must be treated with dignity and respect. Jane Cummings also mentions the 6 Cs (compassion, courage, competency, commitment, care, and communication) of nursing which helps provide support for the delivery of appropriate health services to older adults (in Hollis, 2012). Nurses must therefore be strong leaders and decision-makers in order to help provide and promote improved outcomes among the elderly adults. This paper shall now explore the strategies that nurses can adopt to challenge practice in relation to the care of older people. Body In the effective management of elderly adults, relevant leadership theories include the trait theory, situational-contingency theory, and the transformational theory (Taylor, 2009). The trait theory discusses how leaders are often born with the traits they need in order to be good and effective leaders. Moreover, this theory also suggests that there are specific personalities and behaviour which make the person a good leader (Taylor, 2009). Qualities like assertiveness, confidence, intelligence, as well as sociability are therefore essential skills allowing natural leaders to emerge (Curtis, et.al., 2011). Leaders are born, according to the trait theory and specific behaviour and qualities in individuals are needed in order to ensure effective leadership (Curtis, et.al., 2011). Another theory relevant in nursing leadership is the situational-contingency theory. Based on this theory, leaders evaluate specific situations and their actions would be based on these situations they face (Bolden, et.al., 2003). Under these conditions, the situation, the leader, and the follower are part of the theory. For situational leadership, there is a recognition of the fact that there is no single type of leadership which can work for every situation or person, and that leadership is based on the specific qualities of the situation (Taylor, 2009). In some cases, an autocratic leadership may work well, especially under emergency conditions; however, in other instances, the more democratic style of leadership may work better. Finally, transformational theory may also apply in this case. Transformational leaders evaluate relationships based on critical importance, mostly involving leaders and followers (Taylor, 2009). The emphasis is on empowerment and developing conditions which can secure long-term goals (Taylor, 2007). The primary elements of transformational leadership include the establishment of a shared vision, establishing a bigger vision in managing complicated issues, and creating opportunities for continuous learning (Taylor, 2009). In relation to these theories, various nursing leadership strategies also apply to this current situation. Strategies include: coaching and motivating, communication, and conflict resolution (Sherman, 2006). Coaching and motivation includes the process of cooperation and support. In order for the essential changes to be implemented in the workforce, it is important to establish a supportive and intergenerational relationship within the staff, one which ensures that senior nurses help teach and guide younger nurses (Sherman, 2006). In order to secure strong and effective leadership, communication is also important because it ensures the efficient transfer and sharing of information among health professionals. Communication also involves the process of coordination where health professionals can express the concerns and needs of patients and therefore allow for inter-professional health plan and practices (Sherman, 2006). The UK is an ageing society with about 10 million people being over 65 years of age (Parliament, 2012). Projections also speculate that in about 20 years time, there would be 5 million more elderly people in the UK, with numbers doubling to 19 million by the year 2050. With this ageing population, the burden in elderly care is likely to increase (Parliament, 2012). The issue of elderly abuse and neglect has been a significant problem in the healthcare system, not just in the UK but in other countries as well (Parliament, 2012). The video by Margaret Haywood chronicling elderly abuse in the UK indicates the gravity of the issue. For which reason, a call for change in the care for such population seems to be a crucial consideration in the current state of health care delivery. Changes in the efficient management of such population therefore have to be considered. In order to implement changes in the management of older adults in the healthcare setting, it is important for leaders to have specific qualities of assertiveness and confidence. Such qualities provide a foundation for strong leaders, leaders who can go against the tide and the usual accepted practices in the healthcare setting (McSherry and Warr, 2008). As the treatment of older adults is already deeply set into the healthcare practice, implementing any changes would prove to be difficult. Hence, inherently confident and assertive leaders are needed in order to secure these changes (Avilo, et.al., 2009). For effective nursing leaders, knowing how to assess the situation is also an important element in securing change in the management of older adults. Each patient is different and each patient has specific and individual needs (Sellman and Snelling, 2010). A one-size-fits all management cannot therefore apply. For the elderly patient with cancer and one with diabetes, different management styles apply. As a leader, the nurse has to learn to evaluate what type of management can best apply to the patient and his or her situation (Walker, et.al., 2011). As a transformational leader, the nurse functions based on a bigger vision, in this case, securing a practice which is conducive to the needs of all patients, regardless of their age (Tomlinson, 2012). Transforming the practice requires the nurse to manage complicated issues and to establish opportunities for continuous learning among health professionals. In order to secure change in the practice, leadership strategies would have to include coaching and motivation, communication, as well as conflict resolution (Sherman, 2006). In managing older adults, the senior staff members would have to coach and guide the younger nurses. The coaching process can also work well based on younger nurses working with the more senior nurses in order to change the usual practices in the hospital (Sherman, 2006). Communicating with each other and understanding the basic needs of the patient without considering their age as a factor in management is part of the change transformation. It would likely be difficult to implement changes in hospital settings where certain cultures have already been deeply ingrained (Norris, 2012). However, for assertive leaders, small openings can be made, small changes can be implemented, and eventually the bigger culture can be changed through an eventual transformation of the treatment of older adults. Older adults are more prone to chronic diseases and injuries, including fractures and falls (Kirkwood, 2005). Their skin integrity is also compromised and neglect in their care can cause the manifestation of pressure ulcers which can further lead to the deterioration of their health (Kirkwood, 2005). Some of them also suffer from senile dementia and memory lapses (Heath and Schofield, 1999). This can sometimes cause them to endanger themselves and others, as they may forget to take their medications or even take it twice, or sometimes leave stoves on. They are also prone to falls due to their compromised vision and musculoskeletal function (Heath and Schofield, 1999). Under these health conditions, their needs are very much significant and they are likely to need constant care and supervision. Where the health care delivery system compromises the delivery of their care through discriminatory practices attributed to ageism, these older adults would likely be neglected and would likely suffer further injuries, health issues, and untimely deaths. The importance of competent, assertive, empathetic, and respectful nurses caring for older adults has been emphasized by the Nursing and Midwifery Council (2008) as crucial aspects in the improvement of patient outcomes among the elderly. The essence of care as discussed by Cummings is also crucial in the management of older adults, with aspects already indicated herein, including other elements like care, compassion, and courage (NHS, 2012). Compassion is especially needed in caring for these older adults because understanding these patients as valuable members of society can change the entire picture, it can humanize them as patients (The King’s Fund, 2012). Moreover, taking the courage to express the need for change in the management of older adults can be a daunting process, especially if one is against a well-ingrained system which is also not welcome to change (Reid and Bromiley, 2012). I did not apply the transaction theory because this theory believes people to be motivated by reward and punishment (Taylor, 2009). This did not seem to fit the situation because the change needed here is something which should not be based on rewards and punishment, it should be based on transformational change. Transaction theory cannot support the qualities of leadership needed in this situation, especially as the leader may not even receive any reward for his efforts, only a more altruistic result in relation to the improved health conditions of elderly adult patients (Taylor, 2009). I have chosen to use these sets of skills, over others because they provide the strong foundations for change in the management of older adults and the elimination of ageism in the health care practice. There are significant challenges which I would likely face before any form of change can be seen in the practice. These challenges include the system itself, one which is suffering financial difficulties, and one which is reducing allocations for the care and management of the elderly. As transformational and assertive leaders, it is important for nurses to express to the other nurses as well as the concerned authorities in the hospitals that quality care, as well as respect for the dignity of older adults is an important goal which has to be protected (Tomlinson, 2012). In the management of skin integrity, it is important for the nurses to be leaders in elderly care, ensuring that patients are kept mobile, and if bed-ridden are turned on their side at least every two hours (Miller, 2009). These simple activities help prevent pressure ulcers. Where such practices are not being carried out, the nurses have to consider the situation of the patient, his needs, and his dignity. He may not be able to mobilize independently and would likely need assistance from the nurses; and he may also need assistance in changing clothes which may be soiled or sweaty (Miller, 2009). Soiled and wet clothes may promote infection and the development of pressure ulcers. The nurse applying the elements of coaching and communication can teach and guide other nurses to follow her lead in keeping elderly patients dry, clean, and mobile. In the end, these interventions and practices would help ensure that these patients are not being neglected in their care (Tadd, et.al., 2011). The cost of implementing these changes in the practice would be very much significant, especially as more nurses would have to be assigned in order to manage older adults (Lievesley, 2009). The shortage of nurses in general have led to higher patient-nurse ratios with more patients assigned to each nurse, and with longer shifts worked by each nurse. Therefore, securing the goals established above would prove difficult under these conditions. In order to secure such goals, increased allocation for nursing personnel is needed (NHS, 2012). Admittedly, the budget for healthcare is distributed to a large population, from infants to the older adults. In assessing cost effectiveness, the government considers the older population unproductive members of society as most of them are retired and are suffering from chronic diseases (NHS, 2012). As such, budget cuts have been made on allocations towards elderly care. As transformational leaders, it is important to assess the cost-benefit ratio of the situation based on past contributions to society as well as to what man and society owes to the dignity of its most vulnerable population (Norris, 2012). Although the cost for elderly care is not commensurate to the benefits which man can take from such care, the principles of healthcare delivery are not founded on monetary considerations alone (Woodhead and Fudge, 2012). As pointed out by the Nursing and Midwifery Council, it is the responsibility of the government to encourage nurses to establish a favourable attitude towards older adults and secure positive feelings of respect and understanding for older people, majority of whom still have the potential to be fruitful and productive members of society (Woodhead and Fudge, 2012). The care of older adults is also based on the importance of valuing older people and promoting opportunities in securing their wellbeing and mental health (Tadd, et.al., 2011). One of the issues in the delivery of effective health services to the elderly population is the nurses’ lack of sufficient knowledge on the appropriate care of older adults (Hertzberg and Ekman, 2008). Limited knowledge on proper care can exacerbate the abuse which these patients suffer. Without knowing what specific care each patient needs, the elderly patients would likely suffer neglect and an exacerbation of their symptoms (Tadd, et.al., 2011). Where nurses do not know the preventive interventions for pressure ulcers, for falls, for hypertension, and senile dementia, older adults would likely continue to suffer neglect and poor health care services (Tadd, et.al., 2011). Limited resources, especially with limited staff can make quality care difficult to carry out (Hertzberg and Ekman, 2008). Resources would be spread thinly and at best, the patients would likely only receive immediate but not focused, deliberate, or quality care. Ethical issues which relate to the management of older adults mostly relate to the application of the four ethical principles as laid out by Beauchamp and Childress (in Summers and Hoffman, 2006). These principles include: beneficence, autonomy, nonmaleficence, and justice. Beneficence involves the importance of doing good for the patient, in some cases doing the greatest good for the greatest number. Although the elderly population does not represent the greatest number, such ethical principle is subordinated over the nonmaleficence principle, that of doing no harm to the patient (Summers and Hoffman, 2006). In relation to competing and conflicting ethical principles, nonmaleficence principle is given greater credit because it encompasses specific individual rights, especially the rights of the vulnerable members of society, including the elderly (Summers and Hoffman, 2006). There are specific associations seen between the style of leadership and the patient health outcomes (Hay Group, 2008). Nurses manifest leadership through person-centred care and by working with the patients, the families, and their colleagues. In relation to the skills and behaviours which refer to person-centred care, leadership also involves the process of listening, interpreting as well as confirming understanding (McKenzie and Manley, 2011). It also includes the process of evaluating and reflecting on the efficacy of the interaction. Clinical leadership ensures a chance to manage and incorporate essential skills towards activities which are needed in order to deliver quality care responsive to the needs of the elderly population. Conclusion There is rampant discrimination and ageism in the current healthcare delivery system. As a result, older adults are often suffering neglect and abuse from health professionals including nurses who are not delivering timely, quality, and appropriate care. The fact that the life expectancy and the productivity of these older adults have already been compromised seems to affect the efficient delivery of health services for these patients. Nursing leadership is an important element if change in the practice can be efficiently secured. The trait, situational, and transformational theories provide the basis for leadership change in this case. For leaders possessing the assertive and confidence traits for leadership, possible changes in the practice can be implemented, especially where various nursing styles and practices have long taken root within the system. Specific patient needs and situations call for the application of the situational theory which calls for leaders to make the adjustments based on individual needs for individual patients. The transformational theory calls for major changes to be implemented in the practice; it calls for a bigger vision and more altruistic goals for health delivery. These theories provide the foundation for effective change within the practice in the management of older adults. As a leader therefore, it is important for me to be confidence and assertive, to consider the situational elements for each patient, and to establish a vision and goal for more significant changes in the practice. The importance of communication and motivation among leaders is also highlighted above, especially in relation to the communication between and among nurses, patients, families, caregivers, and other health professionals. Implementing change is based on strong leadership skills and goals with nurses working as a unit in order to eliminate ageism and elderly abuse and neglect. It is important for nurses to continue to learn and evolve in their practice. New skills have to be learned and old as well as inappropriate practices, including ageism has to be discarded consciously by these nurses. I was able to develop the key skills of leadership by being more assertive and confident, taking the lead in managing older adults, especially when other nurses would neglect their care. 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