Critical Review

The sequential age of 65 years is recognized for an older person by many of the developed states in the world.However, the chronological age varies significantly from an individual’s functional age and the changes related to age that happens at different levels in different individuals. The population of elderly persons in the community is raising all over the world. For instance, the number of old persons aged 65 years and above in Irish is over 11% of the population.  Life expectancy rate has steadily been high over the previous years caused by significant improvements in illness control and prevention using antibiotics and vaccines and proper hygiene. In modern society, the elderly population is growing living longer due to advancements achieved in the treatment of recurring illnesses, neurological and cardiovascular illnesses and even cancer. However, the effects caused by diseases related to age leads to high rates of disabilities during late stages of life which may create an actual risk as to the maintenance of well-being and independence.(Moore, 2017).

The nursing and health’s major principles used in elderly care were recognized to be of importance in nursing. Both the principles and the Code of Professional Conduct and Ethics of Registered Midwives and Registered Nurses together with the known aspects that enhance the quality care of the older adults, facilitates the foundation of the nursing framework for caring of the elderly people in every care facilities. There are moral principles that support the practice of nursing in regards to care providence to the elderly. These principles include the philosophy of beneficence, the right to quality nursing care, the principle of control and autonomy and respecting the older people’s dignity(Smebye, Kirkevold, & Engedal, 2015).

These principles are naturally inclusive and focus on capturing the diverse roles and environmental aspects of nursing practices. They usually reflect the anticipated extent of performance even though there could be new factors that could impact on the practice of nurses in a specific care setting. For every principle, there is an underpinning rationale behind it. The competencies of the management plan are justified by indicators, these indicators are not expected to be inclusive or complete, but their interpretation has to be within the context of a particular setting of such a nurse. The indicators can further be advanced to address specific practice contexts and competencies needed.

Health issues:

With the rapid increase in the portion of the older population over 75 years in most developing countries, cognitive impairment is an increasingly frequent issue that requires immediate medical assistance (Ryan et al., 2018). In the clinical setting, dementia considered as one of the biggest global health challenges in this century. A study by Oliver, Wilson and Malpas, (2017), suggested that currently, 44 million individuals around the globe living with dementia and the prevalence are 40% in people who are over 9 years of age. O’Sullivan, Hocking & Spence, (2014), suggested that over 48000 New Zealanders are recently living with dementia and it will be 75000 by 2026. In 2011, New Zealand has estimated that approximately 4100 of the New Zealand population had dementia. Of that population, 4% population of Maori had dementia and 1.9% of populations of Pacific nation were suffering from dementia (Tordoff et al., 2014). Currently, only 60% of the population with dementia was diagnosed, a significant number of cases of dementia were unreported which in turn contributed to the economic burden of disease. In 2016, the prevalence of dementia is higher amongst females (35,254 people, or 56.6%) as compared to males (27,033 people, or 44.4%) (Malhi et al., 2015). The increased rate of dementia in women usually observed at the age of 75 or higher Dementia is referred to as the neurodegenerative disorder considering a syndrome which occurred by a number of progressive symptoms. Consequently, these symptoms influenced the memory, thinking the behavior of the patients and eventually they failed to perform the daily activities efficiently (Scotter et al., 2017).  According to Barnes et al. (2015), one of the unique features of dementia is it affected every individual differently. However, common symptoms of dementia are memory loss, difficult to concentrate, difficulties in carrying out daily activities, being confused about time and places, frequent mood change (Tse et al.,2018). Untreated dementia often gets worse with an increase of age. Accumulated evidence exhibited that most common cause of dementia is Alzheimer’s disease.

a. The right to quality nursing care

A study by Adamowicz et al. (2017), stated that vascular dementia is the second most common cause of dementia after Alzheimer’s disease (Wilson et al., 2016). Few people exhibited mixed dementia consisting of symptoms of both vascular dementia and Alzheimer’s. Authors reported that onset dementia usually caused abrupt and instant loss of mental clarity but it is asymptotic (Tse et al.,2018). It takes months to years to develop dementia which further worsens if remain untreated for the longer period (Tordoff et al., 2014). Due to the high cost of long clinical treatments,  a considerate number of individual in New Zealand with dementia or who are at higher risk of developing dementia refuse to seek clinical assistance which further contributed to the maximization of the economic burden. The total economic cost of dementia was s $1.7 billion in 2016 and individual cost $26,904 that comprising direct healthcare and indirect productivity (Oliver, Wilson & Malpas, 2017). Total health system expenditure is $1,105.3 million, which paid by the government, individuals and others (Tse et al.,2018). In 2016, the cost of community care was $67.3 million. Other cost includes general practitioner visits, imaging and pathology, and allied health. Eventually, dementia is one of the growing issues that need to resolve in order to decrease the high mortality rate (Oliver, Wilson & Malpas, 2017).

According to Adamowicz et al. (2017), age is the greatest risk factor for developing dementia. Other risk factors involve physical activity, smoking, excessive alcohol consumption, head injuries, the poor diet containing high saturated fat. There are four forms of dementia, which involves Alzheimer’s disease, vascular dementia, Lewy Body disease, Frontotemporal dementia. A study by Gibson and Richardson (2017), Alzheimer’s disease is progressive dementia with loss of neurons and due to the presence of two main microscopic neuropathological hallmark: extracellular myeloid plaques and intracellular neurofibrillary tangles which acts as primary markers for detecting dementia (Lohith et al., 2018) . Gibson and Richardson (2017),  stated that it starts with word-finding problems, confusion,  progressing to more severe memory loss, changes in the personality. However, the symptoms solely depend on the affected area of the brain.

According to Adamowicz et al. (2017), Vascular dementia is the second type of dementia which caused by the poor blood supply to the brain which further resulted in a stroke. Vascular dementia begins with a sudden stroke, which worsens the blood supply in the brain. Lohith et al., (2018), stated that dementia by Lewy bodies caused by abnormal clamps of particular protein developed inside the nerve cells. Consequently, it causes changes in movements, thinking, behaviour and alertness. Another study Sarro et al. (2016), stated that people often exhibit normal functioning to confusion within a short period. It is often observed that patient have a hallucination, seeing things, which are not real. In severe condition, dementia gives rise to the symptoms of Parkinson’s disease.Frontal temporal dementia is a group of conditions, which affected the frontal lobe of the brain.

Individuals with defective frontal lobe often exhibit difficulties with planning, organizing, controlling emotions and maintaining appropriate behavior (Wilson et al., 2016). Difficulty in speaking and understanding the language also observed, symptoms often begin in the 50s or 60s.  Eventually, these four forms of dementia contributed to the mental health issues such as major depressive disorders, anxiety, confusion or other cognitive impairments. From the clinical standpoint, it is often observed that most of the individuals with dementia usually failed to answer any questions when they were enquired in the clinical premises. The prime reason behind it is cognitive impairment (Oliver, Wilson & Malpas, 2017). Current evidence also reported that dementia is one of the leading causes of fall injury and hip fractures (Barnes et al. ,2015). Nurses play a crucial role in aged care for reducing the prevalence of dementia.  Therefore, in order to reduce the occurrence of dementia and manage the symptoms of dementia, a major nursing care plans (Oliver, Wilson & Malpas, 2017).

Pathophysiology of dementia

Carthon, Lasater, Sloane and Kutney-Lee (2015) Posits that the elderly persons are a diverse population who have broader range stories about life, capabilities, experiences and have a wide range of multifaceted and complex requirements. Various aspects impact them uniquely together with the effects of the process of ageing, environment, and operations of illnesses. These factors influence their self-being and also affect their view on what is a quality life. Reducing vulnerabilities encountered by aged people is the core aim of person-centered care. Thesevulnerabilities consist of both the individual’s identity threats and as well asthe compromising physiological factors. Therefore anywhere the aged access health care, be it in a community surrounding, hospital or in the care facility, exhaustive nursing care that is person-centered is much needed. Care to older people should be offered by nurses who are vigilant, skilled, motivated positively, and knows about taking care of the elderly.

According to Banerjee, Armstrong, Daly, Armstrong and Braedley (2015) quality nursing is about having a better understanding of an individual, who they are and their values. It involves care directed at avoiding possible occurrences and bad encounters for elderly persons. Nurses who know persons can see beyond the ageing veil, disability, and disease. Person-centered care comprises providing choices, empowering and encouraging the elderly in all care decisions as well as offering continued education and assistance to the family playing a part in the care of the aged persons. The organizing structure by which nurses provides care consists of identifying needs, assessing, evaluating and implementing nursing care. This structure is the basis of making clinical decisions and captures all significant actions undertaken by nurses while offering nursing care.

According to Carmona-Torres et al. (2017), offering the most preferred social and physiological care setting helps elderly persons in keeping their integrity, pride and attaining their potential. Friendship-centered care is core in this case. It is significant to understand the older person’s point of view and knowing them personally. This requires non- verbal and verbal communication skills, presence and listening.  Instances where the capability of elderly persons to understand language may be impaired substantially, the non-verbal habit that tags along the inquiry of opinion and asking permission will portray to the aged that they also have value.Apart from possessing effective communication skills, nurses are expected to be knowledgeable and appreciate the difficulties and communication barriers while handling older persons. This challenges are caused by intellectual incapability, cognitive or sensory status, culture, physical changes and be able to employ approaches to assist overcome such challenges.

Drageset, Eide, and Hauge (2016)suggest that challenging behaviors could be a means of communicating specific demands or may be a sign of mental health illnesses, medical problems, delirium or organic brain illness. Other possible reasons include; anxiety, loneliness, vulnerabilities, alienation are high when the identity of the elderly persons is the touchstones which indicate they miss their surroundings. Attain valuable life for elderly persons is dependent on competency and how knowledgeable the individual-centered to care holistically. It should be offered in a manner that encompasses respect for dignity, compassion and appreciating the entire family and person.

b. Nursing management of patients/clients with respiratory or cardiac medical-surgical conditions

According to Peicius, Blazeviciene, and Kaminskas (2017), this principle specifically emphasizes that should eliminate harm, facilitate good and prevent harm for their patients. While offering health care the significant evils to be reduced and prevented may involve illnesses, suffering, disability, pain, and death. Equally, the essential goods to be advocated may include health, well-being, life, and better functioning. It must be established if at all the suggested medical treatment will lead to the elimination and prevention of harm or enhance good for the patients in case the principle of beneficence is to be applied.

However, a disagreement may never fail to arise about this principle. Hughes, Bigby and Tilbury (2017)used an instance whereby, given that death is usually regarded as harmful to be avoided and promoting of a good life, there are medical conditions that challenge this description. Some members of the family may opt that their beloved one is in a vegetative state as means of promoting good life and preventing harm even if it may demand hydration and continued artificial diet to save their loved one’s life. However, health caregivers may perceive that continuing life which requires artificial to be maintained artificially, is harm that should be eliminated whereas what is good for a patient is for them to die naturally.

Clarke et al. (2017)propose that this principle demands that nurses have a right take an action that is for the best interest of the patient in complex situations. Questions could arise concerning the pointing out of harms for specific and individual medical interventions. Furthermore, it is common that medical interventions come with both goods and evils, usually known as benefits and risks. Situations where caregivers decide to prescribe specific medications, they must compare the probable harm and the expected good. Therefore, nurses may propose medications putting in mind the predicted good and the likely damage this being for the better good of the patient.

Van Wijngaarden, Leget and Goossensen (2018)are of the opinion that a physician who indicates that a frail old patient should not be revived in the event of natural death is aware that it will lead to their eventual demise. In such a case the doctor may believe that there is no harm done if a patient died naturally, but this is good that is being promoted. Death is usually regarded as harm; the physician can tell if CPR may lead to grievous harm compared to the death of the patient. This may not be in line with the views of other practitioners, or the family is given that the risk of breaking ribs and different outcomes of invasive and aggressive interventions are less harmful compared to death itself.

Autonomy according toRodríguez-Prat, Monforte-Royo, Porta-Sales, Escribano and Balaguer (2016) is explained as the capability to believe in oneself or merely the ability of an individual to form decisions on their own. In a health care setting, such abilities include communicating and establishing health care choices. This principle requires patients with such skills be allowed to refuse or accept alternative treatment suggested by a physician. The most critical requirement of this principle is the informed, voluntary consent.

c. Nursing management of patients/clients with neurological and haematological/vascular medical-surgical conditions

Clarke, Galbraith, Woodward, Holland and Barclay (2015) patients with the capacity should be offered complete, accurate and relevant information in regards to the treatments recommendations and every alternative such as probable risks and expected goods and the consequences of rejecting or accepting treatment. This information must be well understood so as they can form a decision voluntarily without undue influence or coercion. Doubts have arisen when determining the individual capable of formulating decisions. One of the issues includes minors who are mature, young individuals who have not attained 18 years.

According to van Wijmen, Pasman, Widdershoven and Onwuteaka-Philipsen (2015)other challenges involve people in the middle and early stages of Alzheimer illness. Examining the capacity of such a patient in making medical choices may be a solution and also realizing such a patient can make decisions of a specific nature. However, those have a question capability to make decisions must be fully informed to understand and given a chance to capacity and age relevant decisions.

In the management of the principle of reviewed literature, this article applies the competencies of nurses that can be observed about their indicators. The indicators are not expected to be all-inclusive or complete, but their interpretation should capture specific practice environment of such a nurse. This may also be developed further to include certain practice contexts and competencies required. They are grouped as in following criterions;

The ethics and professional practice management is fulfilled through the undertaking of the following criteria;

Professional responsibility and accountability practiceshave various indicators expected of nurses such as practicing according to the legislation, relevant guidelines and professional regulation in the care environment and within their practice. Nurses should be able to integrate exhaustive and accurate ethical knowledge as well as demonstrate respect and safeguards beliefs, rights and cultural values of elderly persons(Rahman, Norton, & Grabowski, 2016).

There are practices under the individual’s competencies that allows nurses formulate ways of developing individual competence. In this criteria, the indicators nurses possessions include the ability to accept responsibility and accountability for outcomes of their omissions and acts while taking care of the old persons. Nurses should draw their scope of practice by observing the Nursing and Midwifery practice regulations and evaluate critically and supports practice using relevant evidence. Nurses should also realize their capabilities and extent of their professional competence(Lee & Coughlin, 2015).

Management fulfils this by systematically conducting a comprehensive assessment of the needs of the aged persons applying the evidence-based theory and nursing practice. This criterion has the indicators nurses should have include actively engaging the elderly and members of the family in identifying needs, expectations and perspectives. Nurses should administer and choose reliable, legal and age proper screening and assessment equipment as well as conducting an extensive assessment of elderly persons.

In the criterion of pinpointing the older adult’s needs for nursing care nurses should possess certain indicators such as they should partner with the older adult to identify their needs. Nurses should utilize and undertake critical assessment information by applying the nursing diagnosis system of classification. They should apply skills in making clinical decisions to point out problems, goals, and needs of elderly persons. Nurses should also be able to recognize actual and probable health risks and issues such as stress and the outcome for the family of the older adult (Bing-Jonsson, Hofoss, Kirkevold, Bjørk, & Foss, 2016).

d. Principles of rehabilitation nursing

This management is fulfilled maintaining and establishing therapeutic caring interpersonal relations with the elderly and their family members. This criterion nurses should have certain indicators such as creating and making sure that the surrounding is calm and conducive for caring, communicating and knowing the patient. The nurse should enhance engaging communication with the elderly and family as well as communicating relevant information and offering sensitive assistance to the elderly.

In the criterion of active encouragement to the well-being and empowerment of elderly persons, nurses are expected to have certain indicators. They include facilitation and support of the elderly to communicate their choices concerning personal surrounding for day patterns and care and enhance flexibility. Nurses should also grant chances and encourage the elderly to exercise their responsibilities and rights and make sure that they can be capable of making individual decisions(Edvardsson et al., 2017).

Management in the old care is effectively done within the various disciplinary teams. In this criterion,nurses should have certain indicators such as partnering with multiple healthcare staffs in offering good practice and setting up consultation measures concerning referral and practice. They should also organize the surrounding in a manner that shows respect and sensitivity to the older adult’s needs and family members including traditions, spiritual and cultural values.

The management also enhances and coordinates care, considering decisions of elderly persons and involving them. This criterion expects nurses to possess specific indicators. They include; Nurses should engage other practitioners in offering good practice and means of consultations about referral, consultations, and practice. They should also involve the elderly and family members in making of decisions while contributing and organizing care as well as collaborating with other members of the team in administering proper and safe care in a consistent an effective manner(Skjæret et al., 2016).

Management is achieved through actions to facilitate the professional and personal growth of an individual and others. This criterion nurses should have specific indicators. They include the ability to realize their values, attitudes, expectations and that of other individuals too concerning ageing and their effects on caring of the aged and their family.They should be committed towards the continuous professional learning and long-term learning the old care.

Caring of the aged person’s demands knowledge, effective cultural and linguistic communication skills. It also involves exhaustive holistic assessment and observing behaviors of the elderly persons including their surroundings.  

Without a continuous assessment of competency, nursing care will split apart, and no reflection of preferences and needs will be seen. This is the way in which the old persons express their wishes and values. The relevance of competency assessments consists of various factors to be considered while taking care of the aged persons(Lindskog, Tavelin, & Lundström, 2015). The first aspect is pacingwhere a nurse is granted enough time to contemplate the directives and question to acquire a precise background and level of needs and capabilities of aged persons. Secondly is the multifaceted challenges. Every need or challenge that the elderly person experiences may in most cases be linked to contributory aspects which as a result affect various factors in their lives. Thus it is proper to assess the needs or challenges from every point of an individual’s life. Lastly, functional variationsbecause old age comes with some changes in the body of an individual as well as the capacity to function. Evaluating the effects of those changes is vital. For example, elderly persons who have diabetes and had their upper kneeamputated may experience problems bathing and dressing (Meyer, et al., 2017).

e. Principles of mental health nursing

Conclusion:

Many principles outlined in the literature review pose doubts because they are used in patient care to an individual situation. Questions as to what is beneficial or harmful, what happens when benefits exceed harms or harm exceeds good or where specific harms exceed specific harms. In this case who has the capacity to make medical decisions and also when required medical intervention fails. The physicians concerned should answer this questions based on the given situations. These principles can even contradict because they are only used in specific scenarios. However, when applying the management plan outlined in this article, the elderly can be accordingly modified to assist nurses to gain competency elderly care and also in determining their competency levels. Therefore, it is very is crucial to assess competency because it recognizes multifaceted challenges, pacing, and functional changes while taking care of older persons (Jansen et al., 2017).

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