This essay explores the idea of Person Centred Care and the significance it has in caring for an older patient. Issues related to patients incapable of taking part in their care will also be discussed. Each and every patient should be treated holistically and individually to their own personal needs as part of any nursing care plan. This essay will show this is especially evident in the person centred approach to caring for the older patient.
What is person centred care?
Originally developed by Dr.
Carl Rogers in the 1960s as an approach to psychotherapy, person centred care is an approach to nursing care which involves the patient’s participation in their own care. (Cited by Cox, 2011) It requires a therapeutic relationship between nurse and patient in order for the best outcome for the patient. The nurse’s role in this situation is to recognise the patient as a partner in their care, to provide a network of personal support and practical expertise without directing; only advising and facilitating the patient down their own path to recovery.
(McCormack, 2003)
Why consider treating older patients differently?
Science has taught us of the physiological changes in the body with age. These ageing changes include: the way sickness presents itself in the older body, the response of the human body to the treatment given and even some treatments that may no longer be suitable. Psychological changes affect memory as a result of ageing. There can be a lesser understanding due to the change in technology and medicine over time with more modern procedures and equipment.
(Lippincott, 2011) It is common sense that because the patient is older their patient history could be more extensive than a younger patient. They may have been exposed to contagious illnesses that lay dormant in their bodies until now. Extra consideration to all aspects of the patient’s assessment is significant when treating older patients.
Read more: Essay on Person Centred Care
Older patients incapable of participating in their care
The key element in the person centred approach to nursing care is ensuring your patient’s capability to participate in their own care provision and to cooperate with the multi-disciplinary team (Cox, 2011). There are a few different issues to consider when treating the older patient. Their mental status must be taken into account; are they capable of understanding and following instructions regarding their medication, physiotherapy and diet? Are they independent in their activities of daily living or do they require assistance? If so, does the patient have a preference to the gender of their carer? The patient could be confused as a result of their illness or medication. A further explanation for confusion in the older patient is dementia. The Mental Health Foundation (2006) defines Dementia as “…a decline in mental ability which effects, memory, thinking, problem solving, concentration and perception…
Dementia is almost invariably a disease of ageing” If an elderly patient is incapable of making rationale decisions for their self and unable to cooperate in the participation of their care, the next of kin’s involvement is very important. We as healthcare professionals can only do so much for the patient but it is the next of kin’s decision as what is best for the patient. This student must point out that in this situation the upmost importance of including the patient in any conversations rather than speaking over them to their next of kin.
It may seem obvious, is best practice and is common courtesy but unfortunately it does happen. No matter what the mental status of the patient is, showing them respect and maintaining their dignity is still top priority. As nurses, best practice is ‘promoting the understanding of residents and family members of the nature of dementia.’ (HIQA, 2009) People suffering with dementia often feel confused and agitated and can often develop other problems: depression, incontinence, disturbed sleep, inappropriate sexual behaviour and aggressive actions. This causes a lot of strain on family members hence the importance of educating them on what to expect and where to get help for this mental illness. (The Alzheimer Society of Ireland, 2010)
Holistic Care
Holistic care is another approach to nursing care which is incorporated with the person centred approach. The idea of treating a patient ‘holistically’ is to treat not only the problem presented at diagnoses but to treat the body and its needs as a whole. This is especially necessary when caring for the older patient as illness may present itself differently in the person as a result of ageing, as previously discussed. For example; an elderly patient admitted to hospital with a broken leg will have their vitals monitored and as a result may uncover an underlying heart complaint. The nurse’s role in caring for a patient holistically is to deliver care accurately, safely and effectively in accordance with the nursing care plan. The nurse also needs to promote safety, security and optimal health and must maintain a safe and secure environment. Providing for the comfort needs of the patient is another part of the nurses role. (An Bord Altranais, 2010)
Patient Education
Making every effort to assist the patient to follow instructions will benefit them greatly. Something as simple as writing instructions down on paper for them will make the whole process easier. Any healthcare ‘jargon’ and abbreviations must be avoided to maintain a clear understanding between the nurse and patient. The nurse should look out for any signs of doubt within the patient’s facial expressions and body language. Patient’s often try to pretend they understand for fear of minor embarrassment. This is easily solved with repeating the instructions and making the language simpler, avoiding miscommunication.
Beliefs and Values
There are many issues to be considered carefully when planning the nursing care for the older population especially due to changes over time in beliefs, principles and values. This is why it is essential to treat each and every patient individually to provide them with the best care possible and to offer them every support in improving their quality of life. In this country especially, religious belief and practice is much stronger in the older population, making it all the more significant in making the patient feel happy and comfortable during their stay in hospital. We all know that a happy patient is a cooperative patient; meeting their social, religious and pleasurable needs is a trouble-free way of getting the best cooperation from the patient.
Continuing the person centred care nursing approach after discharge It is always important to consider what will happen to this patient after they are discharged. Is the patient capable of attending to their own activities of daily living unassisted? Will this patient require long term care? Has the patient any family or friends willing to assist the patient at home? Will the patient require a home help service and if so can they afford it? Does the patient have a next of kin? Cooperation with the social worker in this case is essential. For the best possible person centred care the multidisciplinary teams must work together as well as working with the patient listening to one another’s concerns and ideas to result in the best possible outcome for the patient. Every patient over the age of 65 will be referred to the public health nurse appointed to their community. According to the Health Service Executive (2009) the public health nurse organises and delivers the individual home support services modified to their needs.
This student’s outlook on caring for the older patient
This is student will conclude this essay discussing her own personal experience from working with elderly patients on clinical placement and the key things she learned from caring for them. We all know the saying “Respect your elders”. Of course they should be respected and listened to. They have seen more, know more and have worked harder than some of us ever will and for that they should be respected. Time and time again the elderly population have been misconstrued as ‘grumpy old people’. More often than not they are lonely or scared and want someone to talk to or to listen to them, and once you do listen to them you will be enlightened with the most interesting stories.
If they are ‘grumpy’ or agitated they may be in pain or discomfort. This explains the necessity for person centred care. This student is looking forward to returning to working with the elderly on clinical placement in the effort to put the research and knowledge gained from this essay into practice. This essay has expressed a clear understanding of the importance of the person centred care approach when caring for an older patient as a result of in depth research of nursing literature and from this student’s own personal experience from clinical placement. This is student now has a better understanding of the importance of the patient’s involvement in their care and will greatly benefit from researching this practice.
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