Caring for Older People in Nursing

Sue Barker, Sue Barker, Author

• Publisher: Learning Matters
• Year: 2013
• Print ISBN: 9781446267639, 9781446267622
• eBook ISBN: 9781446297490
• Edition: 1
• Topic: Medicine
• Subtopic: Nursing

This book is part of the Transforming Nursing Practice series, written specifically to support nursing students on the new degree programme.

As medical advances become more sophisticated, average life expectancies continue to grow. This presents significant challenges to the healthcare system, and caring for older people is now the concern of every nurse. This book aims to help you understand how to care for older people in any care setting. It uniquely focuses on person-centred, humanised care in addition to physical care, helping you to examine attitudes towards older people in healthcare and combat negative stereotypes. The book takes a positive stance on ageing, celebrating the fact that in the Western world we live longer and healthier with a focus on the wellbeing of the individual.

Key features:

·         Easy-to-read introduction written specifically for nursing students, with a chapter on making the most of your placements with older people

·         Theory is linked to practice through case studies and scenarios, and shows the lived experiences of the older person

·         Linked to the latest NMC Standards and Essential Skills Clusters for degree-level education

·         Plenty of activities help you to build critical thinking and graduate skills.

Chapter 1

The context of nursing older people

Michele Board and Ann Hemingway

NMC Standards for Pre-registration Nursing Education

This chapter will address issues within all four domains of the pre-registration nursing competencies but most significantly the following competencies:

Domain 1: Professional values

2. All nurses must practise in a holistic, non-judgmental, caring and sensitive manner that avoids assumptions, supports social inclusion; recognises and respects individual choice; and acknowledges diversity. Where necessary, they must challenge inequality, discrimination and exclusion from access to care.

3. All nurses must support and promote the health, wellbeing, rights and dignity of people, groups, communities and populations. These include people whose lives are affected by ill health, disability, ageing, death and dying. Nurses must understand how these activities influence public health.

Domain 2: Communication and interpersonal skills.

1. All nurses must build partnerships and therapeutic relationships through safe, effective and non-discriminatory communication. They must take account of individual differences, capabilities and needs.

2. All nurses must use a range of communication skills and technologies to support person-centred care and enhance quality and safety. They must ensure people receive all the information they need in a language and manner that allows them to make informed choices and share decision making. They must recognise when language interpretation or other communication support is needed and know how to obtain it.

Domain 4: Leadership, management and team working

1. All nurses must act as change agents and provide leadership through quality improvement and service development to enhance people’s wellbeing and experiences of healthcare.

4. All nurses must be self-aware and recognise how their own values, principles and assumptions may affect their practice. They must maintain their own personal and professional development, learning from experience, through supervision, feedback, reflection and evaluation.

NMC Essential Skills Clusters (ESCs)

This chapter will support the following ESCs:

Cluster: Care, compassion and communication

1. As partners in the care process, people can trust a newly registered graduate nurse to provide collaborative care based on the highest standards, knowledge and competence.

By entry to the register

10. Acts as a role model in promoting a professional image.

11. Acts as a role model in developing trusting relationships, within professional boundaries.

12. Recognises and acts to overcome barriers in developing effective relationships with service users and carers.

2. People can trust the newly registered graduate nurse to engage in person centred care empowering people to make choices about how their needs are met when they are unable to meet them for themselves.

By entry to the register

2:8. Is sensitive and empowers people to meet their own needs and make choices and considers with the person and their carer(s) their capability to care.

3. People can trust the newly registered graduate nurse to respect them as individuals and strive to help them them preserve their dignity at all times.

By entry to the register

3:5. Is proactive in promoting and maintaining dignity.

5. People can trust the newly registered graduate nurse to engage with them in a warm, sensitive and compassionate way.

By entry to the register

6. Anticipates how people might feel in a given situation and responds with kindness and empathy to provide physical and emotional comfort.

Chapter aims

On completion of this chapter you should be able to:

• explain what we mean by ‘older people’;

• suggest reasons why some people ‘age better’ than others;

• outline the humanisation theory on the care of individuals, regardless of age.

Introduction

When you told your family and friends you wanted to go into nursing they may well have said, ‘You’ll make a wonderful nurse’. But some might have added they could not contemplate looking after ‘all those old people’! No doubt you will indeed make a wonderful nurse, and in this book we aim to explore how best to care for ‘older people’.

During their career all nurses, regardless of their field of nursing, will be involved in the care of older people who will inevitably be part of most families. Therefore it is essential that all nurses have an insight into the unique needs of those aged 65 years and over. The focus of this book is on person-centred care, and introduces you to the humanising theory of care, whereby patients are treated as individuals regardless of their age, ethnic background or diagnosis. Some of you will have chosen a nursing career because you want to care for older people.

The first part of this chapter considers who we are talking about when we say ‘older people’. We will look at reasons why some people appear to age ‘better’ than others and the role nurses can play in supporting healthy ageing. We then introduce humanisation, a nursing theory that underpins the rest of the book. The humanisation theory challenges us to consider each individual, and his or her experiences, and the importance of treating people as individuals regardless of age or illness.

Activity 1.1

Critical thinking

Consider what you understand by the term ‘older people’. Write down briefly who you think ‘older people’ are.

As this is a personal reflection, no outline answer is supplied.

In the activity, you may have listed ‘My grandparents’, ‘People aged over 65 years’, ‘Pensioners’, ‘People aged over 70 years’ or ‘Someone older than me!’ Regardless of age many people will believe that older people are ‘others’. Patients will often say, ‘Why have you put me in a bay with old people?’, although they are the oldest person, chronologically, in the room. You will also observe some patients who appear to decline rapidly as they withdraw into themselves, and perhaps you think ‘so this is old!’ Although the day before admission they were living independent lives, they enter an environment where their age becomes significant, and begin to ‘feel their age’. These feelings arise because as a society we do not value ageing, and make judgements about people because of their chronological age. But who are older people? It may surprise you to know that the World Health Organization (2013b) defines older people as those aged 60 years or over. The National Service Framework for Older People (Department of Health, 2001b) defines older people as 50 years or over. In this book we will be defining old age as those aged 65 years and over, whilst emphasising that this group is not homogeneous. Just as all those aged between 20 and 60 are not the same, people aged over 60 to 100+ are not all the same either.

Ageing population: time bomb or success story?

The needs of older people are worthy of consideration given the worldwide ageing population. In the European Union in 2060 those aged 65 and over will become a much larger proportion (rising from 17 per cent to 30 per cent of the population), as will the over-80s (rising from 5 per cent to 12 per cent) (European Economy, 2012).

Figures 1.1 and 1.2 are two maps produced by United Nations (2012), which highlight this very well.

Figure 1.1: Percentage of the total population aged 60 years or over: 2012

Figure 1.2: Percentage of the total population aged 60 years or over: 2050

Activity 1.2

Critical thinking

Study these two maps and consider the following:

• Why might there be a younger population in Africa, compared to the UK?

• Why is there a younger population in the USA compared to the UK?

• What are the implications of increased life expectancy for individual people?

• What are the implications of an ageing population for healthcare professionals?

• An outline answer is provided at the end of the chapter.

There are implications of an ageing population both for individuals and health and social care providers. In considering these implications it is important to know what happens as we age. What is normal ageing, and what is common in older age? As healthcare professionals we can have a distorted view of ageing since many of the older and frail people we meet are patients, so by definition with problems. We could think that frailty is in fact synonymous with old age, and not appreciate that the majority of older people live well and independently in their own homes.

Look at the YouTube clip of older athletes at the 2009 Sydney World Masters Games, including track and field, swimming, diving and weight lifting (http://www.youtube.com/watch?v=4NWZbVb_DLU&feature=player_detailpage#t=0s). The athletes in the film range in age from their late 50s to 100. The video is a testament to how successfully some people age.

As nurses we need to consider our role in enabling people to stay fit and well and live independent lives, and our role when an older person becomes unwell. We need to challenge negative assumptions about ageing and consider why some people appear to age more successfully than others. Firstly we will consider what normal ageing is, what illness and/or diseases are more common as we age and how we might identify the difference.

What is ageing?

Activity 1.3

Reflection

Figure 1.3 shows baby Mary and her great-grandmother, Nora. Look carefully at the photo and make a note about how you would define ‘ageing’.

Figure 1.3: Mary and her great-grandmother

As this is a personal reflection, no outline answer is supplied.

The photo is a useful reminder that ageing is happening to us all, part of family life, and therefore relevant for all nurses. Mary was aged just two days old in the photograph, and has already aged considerably since her conception! Robert Butler first coined the term ‘ageing’ and spoke about how we should celebrate the fact that we now live longer and healthier lives than ever before. He worked throughout his 83 years to change views of older people and was said to have created a new paradigm for old age. Ageing is a real success story which can be attributed to better hygiene, diet and medicine. Ageing is often defined by chronological age, or the passage of time as an individual matures. But chronological age is not everything: it was Mary, not her 80-year-old great-grandmother, who experienced a life-threatening illness hours after this photograph was taken. Fortunately her open-heart surgery was successful and she continues to thrive.

Black’s Medical Dictionary (2010) defines ageing as:

The result of a combination of natural, largely genetically programmed changes occurring in all body systems. Diseases or injuries may influence these changes, which impair the body’s homeostatic mechanisms; environment and lifestyle also affect the ageing process.

This comprehensive definition refers to the many factors that can influence...

Table of contents

• Cover Page
• Halftitle
• Transforming Nursing Practice series
• Title
• Copyright
• Contents
• Foreword
• About the Authors
• Acknowledgements
• Introduction
• 1   The context of nursing older people
• 2   Placement experiences with older people
• 3   Vulnerability and old age
• 4   Nursing for well-being in later life
• 5   Physical aspects of ageing
• 6   Psychosocial aspects of ageing
• 7   Mental health and emotional well-being in later life
• 8   Ageing in a multicultural society
• 9   Social isolation and loneliness in later life
• 10   Interprofessional collaboration when working with older people
• Glossary
• References
• Index