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CASE STUDY

This case study will follow the journey of Mrs. Alice Smith who is a recently widowed lady being admitted to the aged care facility where you work as an Enrolled Nurse .

Whilst she has some savings, she lives on a pension. Recently he husbands died. He was her primary carer in their private home. Alice was showing some signs of dementia before his death and now since then she has been able to be managed at home with the support of her family visiting twice per day. The family visits have assisted Alice with preparing her meals, attending her personal hygiene and ensuring her house is secure in the evening. Alice is now experiencing difficulty coping by herself in her own home often complaining of feeling lonely and afraid.

After assessment Alice has been approved by the Aged Care Assessment Team to be admitted to a Nursing Home. Alice is very upset at having to leave her private home. Her family, which consists of two daughters, are divided on the decision to send their mother to a nursing home but feel they cannot leave her at home alone or look after her themselves as they both have growing families and work commitments.  

 Alice is eighty-nine (89) years of age and has some hearing and sight impairment, a history of mild cardiac failure and Type II Diabetes controlled by diet and oral medications.  She needs to be aware of her diet because of her Diabetes and while she is usually continent, she does experience some stress incontinence when she laughs or coughs. She walks with the assistance of a wheeled walker due to generalised arthritis in her knees. She needs to take oral medication daily for all of these conditions as well as pain medication for her arthritis. These medications can cause her to become dizzy, lightheaded, drowsy and have some gastric discomfort at times.

You are required to answer the following assessment questions to ensure that you give considerate best practice care to Alice. You will be required to research the information to answer the question, and then use Alice’s situation and admission to show your understanding of the research.

PART A

1(a) Identify positive and negative stereotypical ageist comments and behaviors related to    ageing that Alice may have to contend with.

(b) Discuss your feelings and experiences in regard to caring for older people. This is a reflective question and as such does not require a reference source.

Aged people like Alice demands huge attention and care. In accordance to their condition, an individual becomes stereotype in different situations like when Alice was approved for Aged Care Assessment, she was not ready to leave her private home and two daughters .On the other hand, she needed excessive care as she reflected symptom of dementia and also suffering from hearing impairment, arthritis in knees and Type II diabetes. Apart from this, she complains of being lonely and is afraid at home after death of her husband.

In my opinion, enabling care services for elderly people is the most complex part of health care services because I feel it is important for the health care practitioners to ensure that an old individual feels comfortable in service environment. In addition, I feel convincing elderly people to follow medication is the most difficult thing for which, I sometimes try to manipulate them with talks that helps me in convincing them in taking medicines on time.

 

  1. Identify reasons why Alice may now be having difficulty coping at home. Include the following aspects in your answer:
  • Identify the disease states currently affecting Alice and briefly describe the path physiology of these diseases.
  • Identify the type of medication she may need to take related to these disease processes in order to manage the disease symptoms. (For example, arthritis – type of medication required – anti inflammatory medication).
  • Discuss the risks or side effects that these medications can cause for her.
  • Identify and discuss the feelings or concerns Alice may have about the prospect of moving from her private home to a Nursing Home.

 

Alice is suffering from Type II diabetes, due to which the body sometimes releases inadequate amount of insulin which increases glucose level in blood and can lead to lack of physical activity and obesity. However, arthritis in knees leads to blockage and edema of soft tissues which disrupts blood circulation (Leininger and McFarland, 2012). Increasing blood circulation increases body density and also leads to formation of cystic changes which results in pain and swelling. Apparently, as per Alice’s diseases, it is important to modify her diet and ensure that she takes her oral medication on time like Pain relievers and anti-inflammatory drugs. Physiotherapies on alternate days are necessary care need which can help in controlling her diseases like Arthritis, type II diabetes. Increased pressure on knees and loss of weight also comprises of risks of acute inflammation and cystic changes which can be dangerous for Alice. Thus, as per changes it is possible that she may not feel comfortable under health care services because she is 89 and from past many years she used to stay with her husband, who recently passed away and also with her family who visited her every day twice for helping in food and basic homely requirements.

 

  1. At the moment Alice has decided to remain in her private home until a place in the Nursing Home comes available. Therefore, her family will need to address the following issues:
  • What  would need to considered in relation to her health and safety? 
  • What actions would need to be implemented for her to maintain a healthy and safe lifestyle at home?
  • Identify specific factors that may segregate and/or disadvantage Alice?
  • If a family member or friend was available to act as a live-in carer for Alice, identify the many aspects of care that would also need to be considered  to ensure her well being? Consider also the needs of the live-in carer as well.
  • Identify the  community support services that could be utilized to support Alice’s in home care.

 

 In accordance to health and safety until she gets admitted in a Nursing home, it is important for her family to ensure that she is taking proper medication and following dietary requirements. There is a need of someone at home all the time with Alice to assist her in everyday activities. Leaving her alone can be a major risk with regard to her health and safety.

Early symptoms of dementia and arthritis in knees are health factors which are disadvantageous for Alice.

Regular medication, following diet, regular diagnosis and check-ups, and physiotherapies are the requirements which need to be followed forwell being an care of Alice.

Involvement in societal activities, friendly environment, love, care and assistance in everyday activities support services which can be beneficial in supporting care services of Alice.

  1. Alice is now no longer able to stay at home and as the Enrolled Nurse you are admitting Alice to the Nursing Home. Using the knowledge you have obtained concerning her health issues so far, address the following topics:
  • As she is experiencing some sensory loss, what strategies would you employ to communicate effectively with her?

A Nurse will keep her hands away from face, when talking to Alice which will help her in understanding she wants to say. Facial expressions, gestures and implementing use of sign languages are the best strategies which can help enrolled practitioner in communication with patients suffering from sensory loss (Andrews and Boyle, 2012).

 

(b) In consultation with the Registered Nurse you need to undertake assessments to determine her current health status. Your answer will need to address each of the following points.

  • Describe three (3) functional assessment tools that would be used to help with this assessment.
  • How could you assist Alice to adjust to life in a nursing home. You will need to address aspects relating to her  physical, psychological and social/emotional needs?
  • Identify the preventative health checks Alice will need to have included in her plan of care?
  • Discuss the ways that the care team can include and support the family to enable them to make informed decisions about their mother’s care.            

Mental illness

Physical disabilities

Daily living activities of Alice (Rolley and et.al., 2010)

As per her condition, she is vulnerable to changes and therefore first step will be to focus on her involvement in the nursing home. Further, the practitioner will focus on understanding her basic needs in order to help with her daily living activities. Creating friendly environment with all service users will help in fulfilling her social and emotional needs which will aid in developing sense of living for Alice.

 

Modification in diet plans and medication after every clinical test and check-ups are preventative measures for Alice Care Plan

 

The family will be allowed to visit her every alternate day and also the enrolled nurse will prepare plan of care and diagnosis documents which will be shared with her family to secure interest her family. Thus, informing about all improvement and changes in care plan will be under informed consent policy of Nursing home.

 

  1. Payment / funding for Alice’s care is an important aspect when considering the provision of aged care within aged care facilities. The following points need to be addressed.
  • Research and briefly outline the funding mechanisms that govern the provision of aged care in Australia?
  • Describe the changing demographics of the aging: population and the affect this has on government funding in aged care?
  • From the following list describe two (2) theories of ageing and relate one (1) of these to Alice’s situation and her plan of care.
  • Biological theory
  • Psychosocial theory
  • Disengagement theory
  • Social exchange theory
  • Wear and tear theory
  • Activity theory
  • Identify four (4) rights and two (2) responsibilities that Alice and her family will be made aware of on her admission to the Nursing Home.
  • Identify four (4) Acts and/or Regulations and/or applied Legislation that will affect you as the Enrolled Nurse in working in the aged care setting.

Government subsidy to aged care providers, volunteers etc. are the helping hand to Aged Care Funding mechanism. The mechanism of funding is segregated into three factors that is Complex Health care, Activities of daily living and Behavior (Aged Care Funding Instrument (ACFI) Reports, 2018.).

 

Increasing aged care pollution, developed the requirement of care practice which has further increased the need of funds to govern care services.

 

Psychosocial theory in health care is a situation of mistrust, individual beliefs, hope andwill to involve in certain situation. This reflects service user's insecurity for living, care and wisdom to certain situation of nursing and care practices.

 

Social exchange theory reflects individual negotiation from environment to other. This theory relates to situation of Alice where she was living at her private home with her husband and suffering from various medical problems. When her husband passed away, she lived alone but her family visited her twice a day to help in homely work, she is attached to homely environmental of family but now when she got approved for nursing she is uncomfortable in accepting health care environment.

 

Alice family has a right to participate in decision making for medication of Alice. Right to view and change plan of care which comprises treatment, benefits, risks, illness, discharge plans etc.

Right to ensure safe care environment for Alice.

Right of privatizing personal care needs. However, two responsibilities of Alice family are focused on  ensuring effectiveness care services and safety of Alice.

 

The Health and Social Care Act 2008, Mental Health Act 2016 and Indian Medical Council Regulations, 2002, are focused on etiquette, professional conduct, and ethics and Quality Improvement Act of 2005.

 

PART B

Since moving to the Nursing Home Alice’s dementia symptoms have become more pronounced.

  1. Explain the nature of dementia. Include in your research the following points:
  • What is dementia?
  • Common indicators and symptoms that characterize the disease.
  • Identify other conditions that can also show some of these symptoms?
  • Briefly identify statistics indicating the occurrence of the disease in Australia.
  • Identify one (1) assessment tool that could be used to assess Alice’s deteriorating cognitive abilities.

Dementia is related to memory loss in which the person faces difficultly in analyzing, recognizing, and remembering.

Increase in confusion, behavioral changes, depression, loss of ability in understanding, anxiety, and depression are the common symptoms of Dementia.

 

In case, a person is unable to recall recent events is a condition which reflects signs of dementia.

In case the person is unable to recognize some family member or immediate guardians then this leads to behavioral change which indicates sign of Dementia.

 

In 2011, people suffering from Dementia were 298000 and as per projection it is possible that till 2020 it increases till 400,000 (Dementia in Australia. 2012).

 

Assessment tool for assisting cognitive abilities of Alice will be based on understanding her situation and creating familiar environment in Nursing home. It will be focused on social inclusion with care providers and other service users in nursing homes and meeting with her daughters.

 

  1. Describe safety precautions and strategies that you would use to manage a dementia residents day-to-day challenging behaviours. Include in your answer reference to the following points:
  • Physical triggers to behavior and appropriate nursing responses to these behaviours.
  • Implementing a safe and social environment for the older person with dementia.
  • Use of complementary therapies in care of the older person with dementia.
  • Outline the risks and legal requirements of physical, chemical and psychological restraint.
  • Identify two (2) specific activities that you could implement to assist the older person with dementia to maintain autonomy in their ‘activities of daily living’ (remember this refers to physical, psychological, social and emotional activities).

 

 

Monitoring surroundings in order to avoid behavioral changes because in such case the person becomes vulnerable to environment.

 

Safe and social precautions around person suffering from Dementia, will help in their social exclusion and boosting their spirit for living.

 

Complementary therapies will assist in distracting service users and also will assist in developing their mental ability to recognize and remembering of incidents.

 

Medication and inclusion of service users is the major risk related to physical, chemical and psychological restraint. However, Mental Health Act 2016 is the legislation which helps in setting precaution to challenge behaviors of patients.

 

Understanding interest of people suffering from dementia and making them participate in activities can be a strategy to boost interest of patients. The plans can comprise hobbies, work, family, interest etc. Apart from this, creating friendly environment for the person to seek their interest in specific activities can be helpful in distracting service users from negativity and motivating them for inclusion.

 

  1. Mrs Alice Smith’s physical condition became worse and she passed away.

(a) As an Enrolled Nurse describe the procedure you would undertake in caring for the body of the deceased person.

(b) What support services could the nursing home provide and/or recommend access to, for Alice’s family?

Informing the family or any immediate guardian.

Washing body is a necessary part of Palliative care.

Death certification which comprise details of analysis of individual conditions and cause of death. Further, the care home ensures that family is getting ambulance and necessary requirement to take her body for funeral.

 

  1. Define the term ‘end of life’. How does this differ from the concept of palliative care?

 End of life is the ultimate care situation where the person is alive but is living final few hours of life.  This reflects an individual’s condition where the person’s health problems has been progressed to death or is incurable. On the other hand, palliative care is the situation for the terminally ill service users. It comprises diseases like Cancer, Leukemia, Coronary artery diseases, Acquired Immune Deficiency Syndrome etc.

 

 

References

Leininger, M.M. and McFarland, M.R., 2012. Transcultural nursing concepts, theories, research and practice.

Andrews, M.M. and Boyle, J.S., 2012. Transcultural concepts in nursing care. Journal of Transcultural Nursing. 13(3). pp.178-180.

Rolley, J.X., and et.al., 2010. Nursing care practices following a percutaneous coronary intervention: results of a survey of Australian and New Zealand cardiovascular nurses. Journal of Cardiovascular Nursing. 25(1). pp.75-84.