The Community Health Nurse in an Aging World
Requirements for Elderly Care Essay
1.
Write
an essay on the topic
2.
Format:
1500 words (6-7 pages; Font 14; interline space 1.5; page sizes: top, bottom,
right –
3.
You
should follow APA style.
4.
You
must include a bibliography
for all cited sources and references (not less than 7).
5.
Please,
consider the specific health needs of the elderly, and how these are perceived
both by society as a whole, and by health care staff.
6.
Please,
be sure to show your personal attitude based on received scientific facts and
knowledge.
7.
The
example of the title page is given below.
named after
Essay for Community
and Public Health Nursing
“TOPIC”
Written
by Name and Surname
Student
of the BSN Program
Instructor: Dr. _______________________
MD, BSN
Mark
________
Ternopil, 2013
Nursing
Home Care
In clinical practice,
long-term care (LTC) has become synonymous with nursing home care. LTC for
adult clients with medical-surgical problems can occur either in the home or in
facilities such as nursing homes, subacute units, chronic care facilities, or
rehabilitation centers. In general, long-term
care implies that clients receive care for a prolonged period of time,
usually weeks or months. A small percentage of clients may remain in a facility
indefinitely, perhaps a lifetime. Nursing home care can be very expensive, with
annual costs between $30,000 and $45,000 in the
Nursing homes in
the
Types
of Nursing Homes
Nursing homes can
be divided into residential care homes, nursing facilities, skilled nursing
facilities, and chronic care facilities. Some nursing homes are part of
retirement communities, and others have specialty units, such as dementia,
ventilator, or subacute units.
Residential
facilities include
domiciliary homes, care homes, rest homes, assisted-living facilities, and
group homes. Some of these facilities are small and much like boarding homes
before the advent of Medicare (Ignatavicius, 1998). Others are large
communities managed by national corporations. Many of the larger complexes are
life care or continuing care retirement centers that offer a continuum of
services, from independent living to skilled care. The typical resident in a residential
facility is fairly independent and is able to perform most or all self-care
activities. Employees in these facilities are usually unlicensed staff.
Formerly called intermediate care facilities, nursing facilities (NFs) provide
a custodial, maintenance level of care. Certified, licensed NFs receive
Medicaid funding for the care of residents who cannot perform activities of
daily living independently. Each state has specific guidelines for
reimbursement. Skilled nursing facilities (SNFs, pronounced "snifs")
provide care that requires licensed health care professionals, such as nurses
and therapists. Only a small portion of most nursing home residents are
categorized as skilled and therefore eligible for Medicare reimbursement.
Examples of skilled care include new tube feedings, daily rehabilitative care
for postoperative fractured hips, and care of stage 3 and stage 4 wounds. Chronic
care facilities provide care for long-term, chronically ill clients, such
those with severe head injuries or those who need chronic ventilator support.
These facilities are often managed by county or state governments.
Documentation
in Long-Term Care
Documentation in
nursing homes is highly regulated by both federal and state governments. The Minimum
Data Set (MDS) is a federally mandated assessment form that is completed for
all residents regardless of the level of care or reimbursement system. This
document is an interdisciplinary tool completed by each member of the health
care team. The team develops an interdisciplinary care plan for all actual or
potential resident problems. Depending on the resident's level of care, this
plan is updated every 30 to 60 days, or more often as the resident's condition
changes.
Hospice
and Respite Care Services
Respite care is a service that is receiving increasing
attention. It is aimed primarily at caregivers’ needs. Many older people at
home are cared for by a spouse or other family member. The demands of such care
can be exhausting unless the caregiver gets some relief, or respite—thus the
name of this service (see Chapter 37). Respite care may be available through an
agency that provides volunteers to relieve caregivers, giving them time off
regularly or permitting a periodic vacation. Some skilled nursing facilities or
board and care homes provide an extra room to give temporary institutional
housing for the elderly while caregivers take a break.
Elderly clients may also need a change from the
constant interaction with their caregivers.
Hospice care may
be offered through an institution, such as a hospital or home health agency, or
it may be a freestanding facility existing solely as an inpatient hospice.
Hospices and other agencies providing hospice care offer services that enable
dying people to stay at home with the support and services they need. The
purpose of hospice care is to make the dying process as dignified, free from
discomfort, and emotionally, spiritually, and socially supportive as possible.
Some community health nursing agencies offer hospice programs staffed by their
nurses. It is a service that has been well received by elders, meets important
needs, and is growing in use. Hospice and respite care are two services most
needed and used by the families of clients with AD.
Organization of palliative care
•In any setting
•Based on guidelines and [nursing] standards
•Continuity of care
•Team approach
•Multidisciplinary
•Coordination of care
•Specialized care
•Level of care needed [low, medium, high care]
Levels in palliative care
Depending on
complexity:
–Low care [care workers, volunteers, nurse as a
consultant]
–Medium care [nurses, care workers, volunteers]
–High care [nurses, volunteers]
In our
understanding finding a new balance of Cure and Care in a nursing home means
promoting independence in dependence.
Factors:
–Autonomy and dignity
–Attitudes of healthcare professionals
–Exposure of staff to healthy older people
–Education and training
–Information provision
–Cultural expectations
Spirituality, Advance Directives, and Preparing for
Death
A final need of the elderly, and one that is receiving increasing
attention, is that of preparing for a dignified death. Elisabeth Kubler-Ross
(1975) described death as the final stage of growth and one that deserves the
same measure of quality as other stages of life. Many older people fear death
as an experience of pain, humiliation, discomfort, or financial concern for
their loved ones. Planning for a dignified death is an important issue for many
older people. For most, this includes choosing, if possible, where and under
what circumstances death will occur; being free of financial worries; knowing
that their affairs and their family members are taken care of; having the
opportunity to receive spiritual counseling; and dying in peaceful
surroundings, preferably at home with the support of loved ones (Cicirelli,
2002; O’Brien, 2003).
Some elders make arrangements with a funeral home of their choice,
selecting interment or cremation, a memorial service or a celebration of life
gathering, music to be played, and other personal details rather than leaving
these choices to their families. Others place less emphasis on the rituals, as
was demonstrated by one elder who left these choices to her children by telling
them, “Surprise me!”
Summary
Levels of care are dependent of the product
Levels
of care are dependent of the organization
Levels
of care are dependent of the concept / vision of the organization
Levels
of care are dependent of
Most
important is the level of care who is dependent of the wish of the ‘client’
Hospice “De Winde” in the Netherland city of
Enshede.
The dining room in the “De Winde” Hospice
gives the possibility for socialization of its clients: having coffee or some
parties together, inviting friends and relatives inside.
Relaxation room is a part of holistic care: a
place for meditation, prayer.
There is a peaceful environment in the yard of
the hospice.
Boards with photos of all the staff members of
the hospice give clients and their relatives possibility to be familiar with
them.
The
rooms in the hospice don’t look like hospital rooms: it’s a house. Clients are
encouraged to bring their own staff from their home.
Allender,
J. A., Spradley, B.W. (2001). Community Health Nursing: Concepts and
Practice (5th edition). Lippincott Williams & Wilkins; 5th edition
(January 15, 2001). 799 pages. ISBN-13: 978-0781721226. Chapter 30, Pp. 719-726.
Stanhope,
M., & Lancaster, J. (2000). Community and Public Health Nursing (5th
Edition)
Stanhope,
M., & Lancaster, J. (2006). Foundations of Nursing in the Community:
Community-Oriented Practice (2nd Edition)
Allender,
J. A., Spradley, B.W. (2004). Community Health Nursing: Promoting and Protecting the Public's Health
(6th Edition) Lippincott Williams & Wilkins, 2004. – 992 p.
Additional readings:
Age-friendly
Primary Health Care Centres TOOLKIT // World Health Organization, 2008.
Cicirelli,
V.G. (2002). Older adults’ views on death.
Ebersole,
P., & Hess, P. (2004). Toward healthy aging (6th ed.).
WEB SITES on Aging
American
Diabetes Association, Facts and Figures: http://www.diabetes.org
Assisted
Living Federation of
National
Institute on Aging. http://www.nia.nih.gov