Nurses across the world are currently facing difficulties on how to appropriately manage the complexity of care that is needful for the increasing number of older people with related co-morbidities who are being hospitalized to the healthcare system that is already constrained economically. Population aging is an indication of the rise in levels chronic diseases; thus as people approach their middle old age, they need knowledgeable and skilled nurses who can deliver quality care required to meet their unique health needs. Bodilsen et al. (2013) observes that the moment the vulnerable old people are hospitalized, they become more disposed to debilitation due to a decline in their functional ability. If there are no established principles of nursing management of older people in the hospitals, these debilitated aged patients are likely to be discharged faster and sicker with a high possibility of not going back to their homes but instead being admitted to long-term residential care with minimal chances of ever being discharged (Leppin et al., 2014).
Furthermore, there is a high probability of being readmitted to the hospital in a more susceptible state. Therefore, the quality of life for the aged adults radically changes as they are often coerced to permanent physiological and psychological degeneration (Beerens et al., 2014). Thus, there is a need for the establishment of the Principles of nursing management of older people requiring aged Care in all institutions that handle older people to ensure that they receive quality care. This paper aims at ascertaining the principles of nursing management of older people in need of care by conducting a critical review of relevant. The first section will provide the demographics of aging, the principles of nursing management, and a discussion on how the knowledge gained will assist in advancing nurses in their role at the workplace. Population aging is defined as the change in the distribution of a nation’s population towards the old age.
Most of the developed countries have defined an old person to be aged 65 years (WHO, 2018). However, there may be considerable variation in chronological age from one’s functional age, and changes that are associated with age occur at varying rates for different people. According to WHO (2018), there is an increase in the population of aged people internationally. It is projected that the world’s population of those aged 60 years and above will double from 12% between 2015 and 2050. All through history, it has been the trend that the population of the young exceeds that of the old, but the trend is changing. It is expected that by 2020, the population of those aged 60 years and above will be more than the one for five years old. The WHO (2018) reports that 80% of the old people will be residing in developing countries by 2050. Population aging was more prevalent in developed countries in the past decade, but now it’s being experienced in low- and middle-income countries.
The researcher conducted a critical review of relevant journals and websites. Search engines like PubMed and Google Scholar were used to search for literature that reported on the principles of nursing management of older people requiring aged care. The specific key terms used in the search were geriatric, elderly patients, nursing management, principles of nursing management. Based on the review, five principles of nursing management of old people requiring aged care were developed.
Find out and incorporate patient preferences into the process of decision making about the treatment of older adults requiring aged care.
Studies have indicated that most of the clinical practices do not consider patient preferences or values when choosing the most appropriate treatment for patients (McHugh, Whitton, Peckham, Welge, & Otto, 2013). Although older people require critical care, they still can assess choices and have preferences to the care they need. According to AGSEPa (2013), the cohort of aged people has the capacity to ascertain the risks and benefits of treatment when making decisions on which medications to be administered. Thus nurses should be conversant with the preference of the patients regarding their treatment priority. Roland and Paddison (2013) note that patient preferences can be prioritized based on the intricacy level of the situation and the benefits of the preference.
The clinician can begin by determining whether the resident is undergoing a situation that is sensitive to preferences. The healthcare provider should then ascertain the importance of choice to the patient and if it violates any organizational policy or not. An example of such a situation is an intervention that may be beneficial in the long-term but detrimental in the short-term — drugs for disease prevention that have harmful effects, e.g., Statins which lower the risk for the cardiovascular disorder but is likely to result in mental damage (AGSEPb, 2015). The old patients who are to receive the treatment should be notified on the potential risk and benefits of the available options of treatment. Schenker, White, Crowley-Matoka, Dohan, Tiver, and Arnold (2013) elucidates that the risk level of harm or advantage of the treatment should be described using frequency terms such as rarely, frequent, etc. then the preference of the patient can be solicited from an informed point of view.
Consider the intricacy and viability of the treatment when making clinical management decisions for old people requiring aged care
Clinicians must recognize and address the intricacy and feasibility of the treatment options for older adults in need of care. Due to the complexity of treatment options for the aged, organizations and researchers have designed frameworks that synthesize the intricacy of treatment and interpret it using measures like procedures in the activity, available options, duration, etc. (Middleton et al., 2013). Pasina et al. (2014) found out that the intricacy of an intervention regime increases the possibility of non-adherence, poor quality of life and cost. McKillop and Joy (2013) found out that patients only consider limited factors such as cost when deciding on the most appropriate treatment option. Furthermore, most of the old people have cognitive impairment and thus do not readily remember the discussions on the treatment options, and thus further affecting adherence (Dodson, Truong, Towle, Kerins, & Chaudhry, 2013).
Since the intricacy of treatment increases when handling older people, an interdisciplinary band should evaluate the capacity of the patients to manage or abide by the treatment plan on a constant basis. An example of the existing tools that measure the ability of medication management is the Drug Regimen Unassisted Grading Scale (DRUGS). Despite the assessment tool applied, the evaluation of the needs should be patient-centered, and the discussion should be personalized and incorporating those closest to the old person. Studies have indicated that continuous medication regimes in addition to the incorporation of management support reduce the number of admissions in hospitals (Black, Johnston, Rabins, Morrison, Lyketsos, & Samus, 2013). The Medication Regimen Complexity Index is an example of a tool designed to breakdown treatment complexity and offers interpretations. The instrument records the number of treatments, examines the forms of dosage, the dosing frequency and administration guidelines (Hirsch, Metz, Hosokawa, & Libby, 2014).
Encourage positive communication with the old people requiring aged care.
Researchers in the healthcare profession has emphasized the significance of good communication between healthcare providers and patients in addition to their family members (Begum, 2014). Begum (2014) found out that effective communication was helpful in preventing medical errors and in developing relationships based on mutual respect. A rapport between a healthcare provider and the old patient can be developed by asking questions regarding the family of the old person or history. Recognize an association by trust, communication, and mutual respect.
Lenert, Sakaguchi, and Weir (2014) suggest that improved communication between the nurses and old people can be enhanced by providing an involving and beneficial environment. Residents should feel protected and comfortable for them to open up and be involved in their management and care. The events and activities designed for the old people should be well-meaning and supportive as a strategy of making the home care more comfortable. Positive communications with the residents can be fostered by providing lecture sessions on end-of-life care and acknowledging health deterioration, morbidity and death as part of life. Begum (2014) suggests that positive communications on matters that affect patients are significant to disease alleviation because they make the patients optimistic and cooperative in the process of medication.
Utilize interventions that maximize benefits, reduce harm, and improve quality of life for old people in need of aged care
Multiple forms of care are delivered to the old people majorly through medications, thus increasing the risk of medication errors and injuries due to different treatments. Nurses that provide healthcare services to the elderly should prioritize the medications and therapies with an objective of maximizing adherence to the most significant drug and non-drug therapies. The adoption of such an approach will work towards reducing the risk of exposure while optimizing benefits. Kaufmann, Tremp, Hersberger, and Lampert (2014) revisits that issue of optimizing the treatment option to patients by asserting that critical therapeutic oversights can take place due to polypharmacy, in situations where there is an addition of essential medications. Ornstein, Nietert, Jenkins, and Litvin, (2013) shows that most of the old patients requiring aged care have also most of the chronic diseases such as acute myocardial infarction, cancer, diabetes, and coronary artery disease. Incidences of adverse drug reactions (ADRs) are most common in those with multimorbidity as a result of polypharmacy. The studies by Mo et al. (2016) have confirmed that changes in pharmacokinetics and pharmacodynamics that are associated with age predispose the old people to ADRs. Minimizing the number of medications with a specific focus on those deemed to be injurious, can be a way of reducing the risks related to excessive use of medication.
One of the strategies to minimize the number of treatments is to determine the interventions that are likely to be less beneficial to the residents. Potentially inappropriate medications (PIMs) in the aged people can be determined by most of the existing standardized statements and measures that have been developed by professionals (Mo et al., 2016). The Beers list contains the recommended drugs to be avoided (AGSEPa, 2013) while the Screening Tool to Alert to Right Treatment (START) provides clear pointers for prescription (Jones & Bhandari, 2013). The objective of these approaches is to determine the medications linked to increased risk of severe events such as falls and to recognize improved healthcare use and costs incurred as a result of these events (Cahir, Bennett, Teljeur, & Fahey, 2014).
Increase knowledge and training in the nursing management of older people requiring aged Care
Existing studies have clearly shown the existence of the relationship between competence and quality of healthcare provided by nurses (Boyle, Cramer, Potter, Gatua, & Stobinski, 2014). The study by Boyle et al. (2014) on the association between nurse certification and patient outcomes showed that certified nurses recorded an increased number of post-admission fatigue evaluations on patients. Boyle et al. (2014) found out that individuals in rehabilitation units that had certified nurses stayed at the units for a shorter period compared to those taken care by unregistered nurses. Healthcare providers should, therefore, be competent and knowledgeable in providing aged care. Boyle et al. (2014) recommends training in the geriatric care of clinical staff as a way of increasing their sensitivity to the care of the old people.
Education in geriatrics should be carried out continuously. There is evidence in the literature of the significance of constant training of clinical staff on eliminating negative attitudes by the aged care providers to the old adults. Liu, Norman, and While (2013) posited that healthcare providers trained in special education perceived seniors with dementia as unique beings instead of being a homogeneous cohort. The continued provision of training in geriatrics is likely to persuade more people to join the area of study, which is expected to help the increasing population of old people.
The knowledge gained in this research suggest several important strategies that if applied will be of help in assisting nurses in their roles.
The review has provided knowledge on the importance of incorporating the preferences of nurses into the process of decision making on matters that pertain to their care. Patient preferences are essential and should be considered by seeking the views of the seniors and advising them on the most appropriate approach. The research provides the steps on how to determine the preferences of the patient. Furthermore, the study offers guidelines on how to consider a patients preference and make decisions that will be of benefit to the patient and the hospital. The benefits of incorporating patient preferences have also been highlighted thus making the review, among other reasons, significant to nursing at their workplace.
The knowledge gained from the critical review will also assist nurses in their workplace by first considering the intricacy and benefits of treatment before making a clinical management decision. This is because the study provides an in-depth understanding of the nurse on the complexity of aged care and how it affects adherence. With such background, nurses will endeavor to apply the cited approaches in determining treatment complexity and thus increasing the quality of aged care.
The study has also provided strategies on how to foster positive communication with the seniors, an aspect that increases the quality of aged care. Additionally, the study underscores the importance of good rapport between healthcare providers and the old patients and the way in which to develop it. Nurses can thus apply this strategy in not only improving the health of the old people but in making their stay comfortable.
The literature review provides more knowledge to nurses on the utilization of the treatments that maximize benefits and reduce harm as a strategy to improve the quality of aged care. Therefore, these strategies provide in-depth knowledge that is most relevant to the current situation of the need for quality aged care to the increasing population of old people.
Conclusion
This critical review has demonstrated the principles of nursing management of older people. Based on literature review, five principles have been developed and discussed in details with regard to their importance, and their association with quality aged care. The projected increase in the population of old people calls for more focus on the principles of providing aged care. Healthcare providers should incorporate patient preferences into the process of decision making on treatment; they should also consider the complexity and viability of the interventions as a way of improving the quality of aged care. Excellent communication and rapport are also crucial in the prevention of medication errors and building relationships based on mutual respect. Additionally, nurses should utilize interventions that maximize benefits, reduce harm and improve quality of life for the aged. These principles will equally have an implication on the nursing profession regarding the quality of care services provided to the aged.
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