Nursing Assignment On Ageing In Place: Wellbeing & Sustainability

Question

Task: Nursing Assignment Details
Read through the following information to understand and meet the requirements of this assignment.

Part A
Step 1: Read Case study 1. You must respond to this case study.

Case study 1
Mrs O has been receiving home care services for several years. She has dementia and her needs have gradually increased, but she is capable of living semi-independently for now. Her two children live nearby and at least one of them visits daily. Mrs O gets on well with the care staff and makes it clear to them that she wants to keep doing as much of her own housework and personal care as she can.

However, her children express concern to the provider that she is no longer capable of making decisions that best meet her needs. They ask the provider to add laundry, ironing and bed-making to their duties, tasks that Mrs O has been doing herself until now without mishap. The care staff who look after her directly tell the service coordinator they think this change is unnecessary and risks making Mrs O unhappy and affecting her confidence. The provider has to balance the wishes of Mrs O’s family with Mrs O’s own preferences.

The main priorities are Mrs O’s safety, her well-being, and respecting her wish to keep doing her daily tasks. There are certain safety and hygiene issues to consider. So far these have not arisen but may as Mrs O’s dementia progresses. A care coordinator with experience in dementia meets with Mrs O to talk about these issues. Mrs O understands the concerns being raised by her children and decides that the risks discussed with her are outweighed by the importance of benefits she gets from doing her own laundry and ironing. She agrees to a small increase in staff supervision for these activities. In explaining the plan to Mrs O’s children, the coordinator emphasises how important it is for their mother to maintain a sense of independence, self-worth and purpose. The coordinator also makes it clear that the provider has carefully discussed the health and safety risks with their mother and will continue to monitor them from day to day, and welcomes further input from the family about their observations of how she is coping.

Step 2: Answer the following questions as they pertain to Case study 1.
1. From your understanding of diversity in older people, explain how Mrs O’s case is different in terms of her needs when compared to some older people living with dementia?
2. If you are the care coordinator, how will you ensure that Mrs O despite her dementia, is able to age in place?

Part B
Step 3: Read Case studies 2, 3 and 4 and choose your preferred second case study.
Case study 4
Soon after moving into residential aged care, Mrs S has an assessment to identify ways to help her with adjusting to her new environment. During this assessment, Mrs S tells the care manager that while she is ‘not spiritual’ and not sure what her religious beliefs are when she lived by herself and was still able to drive, she had gone to church most Sundays. The care manager asks Mrs B some open questions to find out what church meant to Mrs S personally and learns that the weekly services were an opportunity to connect with her community, see people she knew and identified with, and help others by playing the church organ and visiting members of the congregation who were unwell.

Mrs S says she doesn’t mind missing the sermons but does miss the sense of inner peace and connection with ‘something out there’ she felt during silent prayer time. She adds that she regrets not being able to keep in touch with her church community or make the contributions that gave her a sense of purpose and value. After hearing this, the care manager asks if she can look into and help arrange some opportunities to help Mrs S stay connected with her old church. Mrs S is pleased about this and also interested in the suggestion that she consider volunteering her skills as a pianist to accompany the residents’ choir. After introducing Mrs S to the choir organisers, the care manager takes her to see the prayer and meditation room, gives her a program showing when the regular services and meditation groups are held and when the space is free for individual use.

Step 4: Answer the following questions in response to your chosen case study. Make sure you clearly indicate your chosen case study.
1. From the case study you have chosen, identify the main issue and link this to at least one principle of ageing in place.
2. Do you think that steps/actions implemented and planned as described in the case study will contribute to the older person to successfully and sustainably age in place? Justify your answer using the ageing in place framework.

Answer

Nursing Assignment Part A
Answer to Question 1
Dementia is characterized mainly as an old age disease that causes progressive loss of memory and other mental health related issues. An elderly individual suffering from dementia is most likely to experience some other symptoms such as impaired judgment and decision-making capabilities, speech deficit, cognitive difficulties alongside heightened anxiety, irritability and depression. Moreover, it has been noted often that people with dementia express tendencies of repeating statements, incoherent speech and declined cognition in reading and writing. Activities of daily living (ADL) are compromised in such affected individuals thereby hindering optimal wellbeing and overall health of the suffering individual (Davenhill, 2018). As far as the context of dependency in dementia patients is concerned, research has identified certain modifiable factors that help in preserving functional independence among high-risk dementia individuals. Therefore, in order to stave off dependency, maximize quality of life as well as reduce the caregiver burden in such persons, smoking, not drinking and low-income status might aid in predicting the dependency incidence in case of cognitive impairment also (Rist et al., 2015). However, Mrs. O’s needs and symptoms are different in comparison to dementia, as we understand conventionally. She is capable of living semi-independently and aware of her condition and acknowledges her needs as and when required. This is evident from the fact that when her children expressed concerns over her decision-making capacities and doing household chores such as laundry, ironing and making bed, she confirms that benefits derived from performing theseall by her outweighs the risks gauged.

Answer to Question 2
Mrs. O suffers from dementia for many years and she leads a semi-independent life with the help of a care staff as part of home care services. She prefers doing her chores without requiring any help or supervision. She has two children and one of them at least pays her daily visit. Considering her condition, it is imperative for the caregiver to ensure her safety and hygiene as far as possible. Care giving under no circumstances should be compromised. Therefore, as a care coordinator her optimal health and wellbeing should be prioritized in keeping with her wishes and preferences. Positive aspect of care giving has been studied widely across literatures and the evidences provided suggests in favour of implementing and tweaking approaches based on personal needs of the affected individual. It has been cited that Acceptance and Commitment Therapy (ACT) might aid in rendering holistic and quality care to the dementia patient through promotion of mindful acceptance of the present. In this regard, the persona attributes and virtues of the caregiver play a crucial role (Lloyd et al., 2016). Apart from this, family care giving is another vital informal care for lessening dementia burden and positive care giving may be attained through facilitation of three conditions. These encompass social as well as personal affirmation of role fulfilment, circumstances favouring meaning in care giving process in addition to effective emotional regulation of cognition (Doris et al., 2018). Thus, as a care coordinator it is crucial duty to ensure safety and hygiene of Mrs. O first by maintaining the professional boundaries and acknowledging the needs and demands as well as concerns of her and her family respectively.

Part B
Answer to Question 1
In the chosen case study, Mrs. S after being moved to a residential aged care underwent an assessment for the sake of identification of avenues to help her adjust with the new environment. Upon interaction with her care manager, Mrs. S revealed that while she is unsure of her religious beliefs and is not spiritual; however, on bygone days when she could drive, she used to go to the church every Sunday. On further interaction with her through open-ended questions, the care manager noted that on her weekly visits to the church, Mrs. S could connect with her community, meet her acquaintances and people she identified with. Moreover, she could also help others by playing the church organ and paying visit to the sick members of the congregation. Although Mrs. S confessed, she does not miss the church sermons yet misses the connection and inner peace she felt at the time of silent prayer time. She regrets of not being able to reconnect with her church community or making the contributions that gave her a sense of purpose and value in life. Thus, it is evident that the main issue for Mrs. S is that she misses her connection with community in the church and the associated activities. This may be adjudged as a component of principle of ageing that acknowledges continuity of community as one of the principles that directs the ageing-in-place policy (Strandell 2020). Quality of care impacts enormously both the quality of life for the service recipients and the informal care givers as per ageing-in-place principle (Hlebec, 2018).

Answer to Question 2
From the case study, it has been found that post assessment upon hearing the feedback from Mrs. S, the care manager in her capacity tried to incorporate and implement certain changes to make her feel better and adopt favourably with the existing environment. She suggested that she would try to make her reconnect with the old church. Furthermore she advices of volunteering her skills as a pianist and accompany the residents’ choir. She was introduced to the choir organizers as well and thereafter taken to the prayer and meditation room, handed over with the program bearing the timings for regular services and meditation groups. She was also helped with the timing when the space is free for individual use. Evaluation of these measures highlights the fact that the care manager emphasized on sustainable and successful ageing-in-place for Mrs. S by ensuring that all her resentments and unfulfilled wishes are recognized and intervened. Justification may be sought from the ageing-in-place framework itself whereby individual independence is respected for optimal outcomes through suitable interventions that suits the individual needs through individual planning (Tsertsidis et al., 2019).Moreover, continuity of community, continuity of personal relationship aspects as well as integration with generic supports has also been incorporated in this case as she was advised to mingle with the community in the choir and actively participate as a pianist for a sustainable ageing-in-place (Peace, 2022).

References
Davenhill, R. (2018). Looking into later life: A psychoanalytic approach to depression and dementia in old age. Routledge. Doris, S. F., Cheng, S. T., & Wang, J. (2018). Unravelling positive aspects of caregiving in dementia: An integrative review of research literature. International Journal of Nursing Studies, 79, 1-26.
Hlebec, V. (2018). Evaluation of access to long-term care services for old people ageing in place in Slovenia. Slovenian journal of public health, 57(3), 116.
Lloyd, J., Patterson, T., & Muers, J. (2016). The positive aspects of caregiving in dementia: A critical review of the qualitative literature. Nursing assignmentDementia, 15(6), 1534-1561.
Peace, S. (2022). The environments of ageing: Space, place and materiality. Policy Press.
Rist, P. M., Capistrant, B. D., Wu, Q., Marden, J. R., & Glymour, M. M. (2015). Dementia and dependence: do modifiable risk factors delay disability?. Neurology, 82(17), 1543-1550.

Strandell, R. (2020). Care workers under pressure–A comparison of the work situation in Swedish home care 2005 and 2015. Health & social care in the community, 28(1), 137-147. Tsertsidis, A., Kolkowska, E., & Hedström, K. (2019). Factors influencing seniors’ acceptance of technology for ageing in place in the post-implementation stage: A literature review. International journal of medical informatics, 129, 324-333.