• 
  Peter John Ignacio
  
• 
  Jael Wafula
  

Support Planning for Geriatric Health Conditions

Introduction

Today, our society consists of increasing number of people aged sixty five and over. This is the result of the baby boomer effect in which post world war two children are now in the latter stages of their lives. It is believed that institutions which are inclined in supporting the elderly have to be experts in the health concerns that goes along with ageing. There can be a variety of health conditions an old person can have, these include, but not limited to, hypertension, diabetes, arthritis, osteoporosis, vision and hearing loss, skin changes, and mental, emotional and psychological changes. The latter, being the focus of this paper, is mostly referred to as the main concern of the elderly not only here in New Zealand but most of the elderly all over the world. Topics involving this will be examined in this paper, such as, the differentiation of person centred approach and non-person centred approach in care of the elderly, techniques in meeting the fluctuating abilities and needs of elder people with conditions in mentation, impacts of cultural diversity and impacts of health sector standards on the person-centred model of managing individuals with cognitive difficulties, like dementia of senior members of the community and other geriatric related health conditions.

Person-centred approach

First to be examined is the person centred approach which is focused on the elderly person, individual resident, if in a rest home setting; a particular patient, if in a hospital setting; or the senior citizens, in society as a whole. It is the principle of knowing the person being cared for, comprehensively, not only the health concern or the disease that they have. People even in the advance stages of their lives have the right to be treated with respect and dignity. To do this, it is paramount to know the person as who he or she is and how he or she would like to be treated. First and foremost is knowing the name of the patient, resident or any individual being cared for. This is the basic thing to know by heart and not to be undermined. It is easy to forget names at times but it is important to make sure to know and remember names of persons being cared for especially the elderly. This can be done by regularly checking the charts or records of clients and using their names when communicating with them on a daily basis. In turn, this can help in remembering and fully knowing the clients’ names and even furthering the caring relationship between the carers and the people being cared for. In addition to that, knowing clients’ personality and the activities they usually do would definitely help in establishing an outstanding relationship. Things like, hobbies, routines and favourites of the elderly are always good to know especially if they are residing in a facility that would benefit from these personal information for the continuity of care and to have harmonious client carer relationship altogether. In this way, satisfaction of elderly clients would be maintained and honoured. For elderly clients with dementia or similar health conditions, it is also indispensable to protect their rights. Western countries, New Zealand included, and other developed nations are very strict with regards to this. Clients, whatever their age is, should be treated and cared for in accordance to the bill of rights that everyone should respect and pay attention to, especially when caring for elderly clients. Included in this bill is the right of privacy. Privacy is still very important when caring for elderly clients. They are still fully aware of their surroundings and the things that make them uncomfortable should be avoided. The right of choice is also another factor that should be maintained in the life of the elderly. This means that clients have the right to choose of any aspect of their care. They are free to prefer being independent and to preserve their autonomy in everyday decision making, and of course the freedom from coercion or unconsented experiment or study that may be performed for the advancement of the geriatric medical field.

Non-person-centred approach

On the other hand, the non-person-centred approach to dementia and other advanced age related health concerns have a different precepts or premise. There are two common theme considered in the said approach. These are institution perspective and bio-medical perspective. The first one being focused in the welfare of the facility as the name implies. The reputation and the credibility of the institution is utmost important and to maintain a good image to the public, and perhaps to retain the funding provided by the government, institution perspective oriented facilities make sure that the elder clients are well taken care of. While the second one which is bio-medical perspective has its attention directed with the physical anomalies that elderly clients have. The main objective is to treat the disease and prolong life, which sometimes may overlook the most important factor in caring for the seniors, the getting to know part and truly addressing the needs of the clients not just the physical or bio-medical needs but the one that matters the most for clients of the said age group, the social and psychological aspect.

Techniques used to meet needs of individuals with dementia and common geriatric health conditions

To address further the needs and concerns of the senior citizens, there are some techniques used in various healthcare fields and facilities. The first to be discussed is the reality-orientation approach. This is about informing the clients of the current happening or event in the environment. For example, reorienting elderly of the time, date and place where they are at. This technique is very helpful in eliminating confusion and promoting clients’ confidence in performing activities for the day. In addition to the said events to be reoriented, familiar people and family members would facilitate better memory for the elderly. By seeing their relatives or hearing their names and stories about them, clients’ memory will be stimulated hence, vastly promotes confidence and lessen confusion and disorientation. Furthermore, the simplest but most important way to reorient clients is sometimes forgotten, this is using clients’ names always when communicating with them and informing them of activities they need to participate with for the day. For example, when entering a client’s room for his or her breakfast, a carer should knock on the door and politely call the client’s name to wake him or her up and encourage him to eat breakfast and to do succeeding client activities for the day. This will then make the client aware of his or her own surroundings and activities to be done. Therefore giving them confidence and feeling of self-worth.

The next technique which is gaining popularity is the validation approach, it is inclined with accepting the client, understanding and somehow putting one’s self into the shoes of the clients. By doing this, elderly clients will be more responsive to interventions, they will be more active in communication and therefore will be more happy and contented. By agreeing to them and not contradicting their understanding of things it will be easy for the carer to redirect and divert the attention of the elderly to the right path or correct thinking. Thus, frustrations that may lead to depression would be minimized or even eliminated.

Third technique is called assistive technologies. This is all about innovation and creativity being applied for not only practical but most importantly, for humanitarian cause. In this technique, modern equipment that can be used in everyday life are designed to promote independence, reduce risks and improve the quality of life of not only elderly clients but younger people with disabilities as well. Good examples of these technologies applied for the benefit of the elderly are clocks and calendars that have particular properties to prevent disorientation to time and date. Another are locator devices, these can be in a form of key ring or Velcro belts and bracelets that clients can wear and can be activated in cases of wandering and being lost. There is another type of elderly friendly technology that is very useful in ensuring safety and security for clients who are living by their own. This is called “Telecare”. It utilizes sensors that are installed around the client’s home and connected to a telecommunication device. This amazing technology detects environmental changes inside the house, such as, extreme temperatures, floods and even gas leaks. It also senses the client’s movements. For example, if the client is often getting up at night to go to the toilet or if there are risk of falls, this are detected by the sensors and appropriate communication will be submitted to the nominated person. These various forms of technologies prove to be very helpful in keeping the seniors safe and secure while maintaining their need to be independent and fully functional on their own (Alzheimer’s Society, 2015).

Forth to be examined is the reminiscence techniques. The premise of having psychotherapeutic measures that pertains to the life story of the elderly and how they lived their lives, focusing on the good and minimizing the regrets and resentments from previous events in the old persons’ lives. This approach is proven to improve clients’ mood. Cognitive ability and over-all well-being for clients with mild to moderate dementia. In some way it is inclined and similar to reality orientation approach in aspects of involving relatives and family members who are very close to the client and even those who played enormous roles in the life of the elderly in the past. This will lighten their days knowing that they still know and remember such important events and people. This in turn, will give empowerment, independence and autonomy in accomplishing everyday tasks, as aimed by other techniques of meeting senior client’s needs especially ones with dementia and similar cognitive difficulties (The Institute of Research and Innovation in Social Services, 2015).

Lastly among the techniques utilized for elderly clients, there is the holistic approach. This is mainly involved in simple things that comprises the totality of a client’s life. Included in this approach is the environment of the client. Basic things such as how furniture are arranged, proper lighting at home, reduction of clutters and other potential hazards to the elderly would vastly improve the way they live and can minimize or even eliminate accidents that most of the senior people dreaded. Sometimes this fear of mishaps may cause lack of confidence in doing activities on their own, hence, leading to sedentary life style. This then would have a negative impact on clients’ over-all health and may contribute in further deterioration of physical and psychosocial well-being. To alleviate this and supplement the environmental modification, it is invaluable for the carers to have effective communication with the elderly so that techniques of care will yield favourable outcomes. Communication can be in a verbal or non-verbal form. It should be assured that both modes of communication are comforting and not threatening to the elderly. The clients will be more compliant and will be more participative in care and activities if carers use proper, polite and effective communication. In addition to environment and communication, there is the aspect of nutrition and engagement to physical activities for the elderly clients. With older clients, nutrition and hydration is very important to maintain good health and avoid discomforts. For example, discomforts caused by difficulty in elimination or constipation. By providing clients with high fibre diet and encouraging them to increase fluid intake, the said discomfort can be significantly reduced. Finally, it is also a must to engage elderly clients in regular physical activities. Every morning exercises, brisk walking around the facility and simple games with balls and hoops can be of great help for the seniors in stretching their muscles and moving their joints. This will give clients time to spend to socialize with other clients, carers and their family, avoid boredom and minimise development of challenging behaviours.

Impacts of equality, culture and diversity on provision of person-centred approach

The most observable impact of culture, diversity and equality on person-centred approach of care seems to be positive in nature. Mostly positive in the sense that person-centred approach is all about caring for an individual. Having specific plan of treatment and care for a certain client. Applying individualize measures that would meet the specific needs of a certain individual based on culture is a very good example. While doing this, diversity and equality is being respected and recognized.

Impacts of health sector standards and code of practice and other published standards on person-centred practice approach

The health sector has established standards, policies and procedures that have made a huge impact on approaches and measures in managing health concerns of the elderly. The main code that affects person-centred approach is the well-known and widely accepted, Code of Health and Disability Services Consumers’ Rights. This is very good in promoting person-centred care because it emphasises on rights of clients not just the elderly but persons with disabilities and those who are vulnerable in the society. The code implies the respect in clients’ privacy, autonomy, dignity, right to fair treatment and appropriate standards of care, right to complete and accurate information and communication, right to support, rights during teaching and research and the right to complain. All of the said rights pertain to the individual and emphasises on respecting the individual as anyone would like to be respected. It is believed that this is the same premise of person-centred approach in one way or another (Health and Disability Commissioner, 2009).

Conclusion

After analysing various approaches and techniques in managing older people with dementia and other geriatric-related health conditions, such as, person-centred and non-person-centred approach, reality orientation, validation approach, assistive technologies, reminiscence techniques, holistic approach and impacts of equality, culture, diversity and effects of standards and codes of practice in the health sector, it is therefore concluded that people with advance age and are living with symptoms of dementia or age related health concerns benefit the most in care that is inclined in a person-centred type of health management. It is proven that elderly clients live better, maintain or even boost their confidence, retain autonomy or independence, preserve their dignity and have vast improvements in their over-all quality of life with the help of the said techniques and approaches to care which is centred to the seniors themselves.

References

Alzheimer’s Society. (2015). Assistive technology – devices to help with everyday living – Alzheimer’s Society. Retrieved from

http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=109

Health and Disability Commissioner. (2009). Health and Disability Commissioner Code of Rights. Retrieved from

http://www.hdc.org.nz

The Institute of Research and Innovation in Social Services. (2015). Supporting those with dementia: Reminiscence therapy and life story work IRISS Insights, no.4 | IRISS – The Institute for Research and Innovation in Social Services. Retrieved from

http://www.iriss.org.uk/resources/supporting-those-dementia-reminiscence-therapy-and-life-story-work

This paper will investigate the principles of negligence and critically
explore the requirement for an awareness and understanding of the laws that are
involved for safe practice in the health service (NHS Education for Scotland, 2014).  It will consider ethical issues that nurses
will face in practice and the difficult clinical decision-making process. Not
all medical injuries are because of the result of negligence. All health
professionals strive to run a safe medical practice, however still within the
medical system errors are being made. Negligence is defined as ‘a failure to
take proper care of something’, and this seems a reasonable concept and yet stepping
to professional medical negligence it rises to three elements of negligence.
Professional negligence is a complex area of the law where, medical negligence can
only be proved if all components of the three-part test are present on the
balance of probabilities (civil law) or beyond reasonable doubt (criminal
prosecution) (Bryden & Storey, 2011). The three-part test
consists of certain considerations between the health professional and the delivery
in their duty of care. The test is based on the reasonable foreseeability of
harm (Griffith & Tengnah, 2017). These three elements
for the duty of care will not always be separately identifiable, at times they
may overlap and include other influences (Griffith & Tengnah, 2017).

A nurse has an obligation and
accountability within their responsibility to deliver a duty of care to
patients, families and carers (Nursing and Midwifery Council, 2015). Nurses are duty
bound to adhere to The Code, and although not specified it suggests that in the
section Prioritise People, “nurses must make patients care and safety their
main concern, and ensure that patients’ needs are recognised, assessed and
responded to” (Nursing and Midwifery Council, 2015). According to (Beauchamp & Childress, 2013) framework, nurses work to promote their patients’ best interests and
nonmaleficence. There four principles suggest
that all healthcare professional should act to benefit his/her patient. This framework is widely used and considers the medical
ethics in a clinical setting and despite their limitations since their
introduction they are used to teach and evaluate ethical dilemmas in healthcare
(Page, 2012).
Duty of care for personal injury was initially established by Lord Atkins naming
it the neighbour test. His Seminal judgement suggests that ‘you should treat
others as you would want to be treated yourself’, his use of the words of the
parable of the good Samaritans (Thomson Reuters, 2016). This was introduced
following the case of Donoghue v Stevenson [1932] UKHL 100,  (Chapman, 2009)

.

Although in the summary of this case Donoghue
was unable to sue Stevenson for breach of contract it was concluded that
Stevenson owed a duty of care to his consumers, so it was decided that injury
was sustained through negligence in his duty of care (Bryden & Storey, 2011).

In comparison the case of Caparo
Industries Plc v Dickman [1990] UKHL 2 however was more diverse with regards to
the question to breach of duty of care. This case was a different situation, where
there were arguments of public policy documents, so to determine negligence the
three-fold test needed to be established (Hartshorne, 2007).For this to exist there has to a
relationship of proximity between the claimant and the defendant and the foreseeability
of the defendant’s actions and the claimant’s injuries and whether it is reasonable
to impose a duty of care (Tan, 2010). This case was ruled
that there was not a duty of care to the entire public who may or may not place dependence on the report
when forming financial decisions (Hartshorne, 2007). Everyone has the right to respect for his/her private and family
life (Human Rights Act , 1998). However, a nurses’
involvement with others is complicated because the duty of care exists the
moment that the patient or client presents for treatment or care including a
stranger on the street (Dowie, 2017).
According to (Young, 2009),
there still stands a dilemma around what the duty of care means for a nurse in
practice. Can it be argued that there is not a legal duty to nurses all the
time. A duty of care will combine a legal duty, professional and ethical duty,
along with accountability on all these levels (Bond & Paniagua, 2009) suggest that nurses
are not considered everyday citizens. There is no legal requirement from a
legal perspective to a nurse to help in an accident or incident unless they are
the cause, however from a professional and ethical viewpoint they do have a
duty (Dimond, 2015). It is important to balance rights and
obligations and to consider a deontological perspective in practice (Mandal, et al., 2016).

In all cases it is for the
claimant to prove that the defendant was negligent on the balance of
probabilities, this being the case giving the civil burden of proof (Stauch, et al., 2003).Once established
that a duty of care exists between parties it is then that the claimant must
prove that a duty of care was breached (Gerard , 2008).Establishing a breach is one of the three
elements in proving negligence (Owen, 2007).
Demonstrating that the defendant is not negligent if the damage to the claimant
was not a reasonably foreseeable consequence of their conduct (Beever, 2007) It is the likelihood
of harm and whether the defendant had taken all practical precautions to
prevent harm, something that is considered what a reasonable man would do (de Villiers, 2015). The case of Bolton
v Stone[1951] AC 850, [1951] 1 All ER 1078 has  characteristics
within this case in judgement to viewing safety from the defendant’s side (Wilson, 2011).The defendant took
all reasonable measures of safety in to account, however there was always a
conceivable possibility that harm could occur, but this being so extreme an
obligation of care that unable to be imposed in all cases. The Bolam test is an
assessment that came about from the case of Bolam v Friern Hospital Management
Committee [1957] 1 WLR 582. It is used to assess the standard of reasonable
care in negligence cases (Abraham, 2017).As with (Wilsher v Essex Area Health Authority [1988] AC 1074, , 1988) on the balance of probability
could the hospital be held liable, in this case the defendant failed to provide services as per the standards set by the governing
body (Kline & Khan, 2013) Initially the Court found the defendant,
Essex Area Health Authority, liable for the infant’s injuries, citing

McGhee v National Coal Board


[

1973] 1 WLR 1 (Mandal, et al., 2016). Since the case was complex
due to there being a multitude of consequences, proving liability on the
defendant could not be entirely found (Mandal, et al., 2016).However, the
defendant was still liable to give a standard of care of that of a qualified
doctor, and in the first instance McGhee had been wrongly citied. So due to the
number of possible causes it was for the claimant to establish the likelihood
of causation. However, harm is unacceptable regardless of the consequences (Mandal, et al., 2016)

In the case of Chester v Afshar
[2004] UKHL 41) in
comparison to Bolton v. Stone
[1951] AC 850, [1951] 1 All ER 1078 not all reasonable precaution was
taken with Afshar in giving all information to the patient and ensuring the
patient was aware of all risks involved (Thomas, 2009). The principal issues of autonomy, confidentiality, justice, beneficence,
and non-maleficence are significant factors that a
doctor should be mindful and considerate off when making decisions every day (Thomas, 2009). Although it
could not be proven entirely that the lack of information was the cause for
further discomfort, it can be recognised that “but for” the lack of information
Chester may not have continued with surgery. Conversely the “but for” test does
not provide a complete or exclusive test of causation in the law of tort (Stapleton, 2015). On these facts the
judge found that the claimant had established a causal link between the breach
and the injury she had sustained and held that the defendant was liable in
damages (Parliament, 2003).

Causation
of injury is the most difficult principle to prove under the principles of
negligence (Alvarez, 2012).  In proving
causation, it is not enough to show that the defendant’s conduct caused the
injury to happen, it is generally the person harmed that must prove that the
standard of care fell below what is expected of what a reasonably competent
person would give (Voyiakis, 2018). Considering this part of negligence,
the other elements need to be fulfilled so Firstly it needs to be established
what effect did it have on the patient (Griffith &
Tengnah, 2017).
So, finding a causal link needs to be obtained (Avery, 2017). When claiming for a
negligent act compensation is sometimes awarded for damages caused (Bryden & Storey, 2011).There is a
three-year window for claiming negligence from the alleged negligence
occurring, or from when aware of a negligent act (Bryden & Storey, 2011). This assists for
minors until they mature and come of age (Bryden & Storey, 2011).

It is well represented in the case law of (Barnett v Chelsea [1968] 2 WLR 422, n.d.) even though the
defendant was in breach of their duty of care, they did not however cause the
injury. Though, in this case it could be asked could the patient have suffered
due to the breach in care also considering possible phycological trauma to the
family. However, this was a civil action, had it been determined thatChelsea was the cause of death then
this would have become a gross negligence hearing as with the case of R v
Adomako [1995]. Gross negligence does not signify an intention to cause harm,
if it was to be intentional this would be classed as murder (Ferner & Mc Dowell, 2006). It needs to be ascertained
that a breach in the standard of care that was given caused harm (Griffith & Tengnah, 2017). The court are aware
that negligence can also induce psychological upset, so as a result of this
there are instances when the court will award damages to the claimant (Avery, 2017). However contrary to
this there is a distinction made for this to happen, this is primary and
secondary victims (Sowersby, 2014). The distinction lays between direct
involvement and those who become distressed upon discovering about negligence
on another person (Sowersby, 2014). This is well noted in the case law of (Alcock and others v Chief Constable of Yorkshire
Police, 1992)
AC31091-2 Likewise, the case of (Jaensch v Coffey [1984] 155 CLR 549,, n.d.) it
was determined that it was more than reasonable foreseeability, proximity was
also relevant, doctrine was extended beyond those who perceive with their eyes (Vandhana &
Dharshini, 2018).
So, does this warrant a relationship between psychiatric illness and careless conduct
(Raz, 2010). However, in this
case are there ways to have been more aware and demonstrated more empathy, and
did they practice non- maleficence, is this just behaviour. Harm must be proven by an act of
negligence or omission (Dowie, 2017).It
is important to understand that carelessness is not classified as negligence
these acts are a lack of being unmindful, forgetful and inconsiderate (Raz, 2010). In spite of the
elements required to prove negligence, there is the case of “Res Ipsa loquitur”, this is the principle that incidents
can occur where it is appropriate to imply a negligent act (Brenner & Bal, 2015) This is where an act
“speaks for itself” (Brenner & Bal, 2015). This must meet
three conditions to establish a negligent act, as in the case of Cassidy
v Ministry of health [1951].

Conclusion

So, what does this mean to nursing
practice, a nurse is always duty bound by the NMC code of conduct to adhere to
being candour. It is established that it is unethical in medical practice to deliver
substandard care. It is important to understand that actions should be based on
the right intentions. A nurse should understand their principles of duty and
recognise their obligations and the rights of others. Recommendations for
nursing practice would be to always develop and follow through with a good
nursing care plan and remain up to date on the organisations policies and
procedures. It is important to recognise scope for practice and standards
within a work place, and always identify and know their limitations and always
ask for clarification when not fully understanding a task.

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