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  1. Outline the physical, emotional, social, psychological and spiritual issues to be aware of when caring for a person who is blind and elderly

  2. Compare and contrast the different care needs between Patrick and a sighted resident, discuss in particular the difference in dressing and eating need
  1. Describe how you, as a health care worker, would support and assist Patrick to satisfy his social needs
  1. Reflect on key learning achieved during this assignment

Patrick and a sighted resident care needs

According to Peace et al. (2016) Patients, 65 years of age and beyond are susceptible to visual impairment. It even increases when it comes to the 80’s. This is also compounded by other medical conditions that are prevalent among the old. There are quite some issues that affect such an age group. Physically the patient may suffer diseases which are associated with visual impairment for example diabetes, stroke, hypertension and coronary heart diseases. Regular checkup should be conducted to ensure that the person is healthy. Blindness will compromise the patient’s diet since the patient is not able to prepare some nice food. The patient may not be able to some exercises due to the condition thus compromising his health condition. Visual impairment is also a risk factor for depression and hearing loss (McLean et al. 2014, p. 181).

The older visually impaired people tend to feel that due to the disability, they have become a liability. This lowers their self-esteem and makes them lose their social confidence. Since they are not able to carry out the tasks they carried in the society they now feel unfit, unwanted and treated with disrespect. It is, therefore, necessary to offer more care outside the eye clinic to ensure that the patient can stand in the social world and that they can overcome the social stigma.  Senra et al. (2015 p. 858) noted that older people are in the risk of suffering from psychological stress, the reason is that they tend to carry with them their problems due to fear of burdening their families. Their mental health may also get affected by the pressure and anxiety that comes with dealing with visual impairment (Touhy, Stephens & Johnston 2014, p.302). Their spiritual life will get changed since they might not be able to attend religious meetings or read spiritual related books.

Markus (2017 p. 218) demonstrates the different lifestyles between a blind and a sighted person. Both Patrick and his peer requires clean and decent clothes to wear. They may need a person to help them in cleaning and ironing the clothes due to the age bracket. They both need to dress decently. This makes them acceptable in the society. The two peers require some assistance, but Patrick’s needs are more compared to the sighted person. Since Patrick is blind, he will need some help in selecting the kind of clothes that are appropriate for various occasions while the other sighted peer can choose the clothing since he can see the colour and the design. Should the clothes be stained or dirty Patrick will not realize while the sighted person will observe this with ease. Some clothes may have some holes or even require some minor repairs which Patrick will not see, but his peer will see this and also repair the cloth. Some clothes are the same both in the inside and outside, this will be difficult for Patrick to detect.

Supporting Patrick to satisfy his social needs

Both Patrick and his peer requires a healthy diet for them to be physically fit. This can be enabled by the accessibility of the right food materials at their disposal. The food should also be well prepared, and the amount should be dietary fit. Patrick will experience obstacles while shopping, preparing and even when eating in restaurants. It is due to limited access to nutritional information for Patrick, therefore, might be taking food of less quality while his dietary needs are even more compared to his peer. Patrick needs some assistance to get the right diet in his vicinity. When it comes to food preparation Patrick’s peer is in a position to prepare some nice food while Patrick due to his condition will not be able to prepare a good meal.

I will support Patrick satisfy his social needs by counselling him. I will also advise his family on how to take good care of him. I will help him access peer support groups, community guides and befriending services (Kostyra et al. 2017, p. 180). In the peer group support, he will find other people of his age suffering from the same, and this will help him accept himself. In the group information on safety, security financial benefits and necessary equipment is shared with them. They are taught to prepare meals safely. He will get an opportunity to socialise and will be monitored. He will also get a volunteer guide if he needs to go out. I will introduce Patrick to a community guide who will assist him when going out. I will introduce Patrick to befriending services with social caregivers or volunteer. They will have time to share the love and have an open discussion reducing loneliness.

Health is a basic human need.  In the absence of health, any individual happiness is deprived. It is, therefore, necessary to take care of those who are facing health challenges, offer them our support.  Especially when it comes to the elderly, their age predisposes them to other health-related issues. They should be supported both physically, socially, emotionally, psychologically and spiritually. The family should be encouraged to offer any support a visually impaired person may need. This can be regarding cooking for them, preparing their clothes. This helps stop further impairments that may be tailored to the present challenge. Blindness is a major physical impairment, and therefore it is important to have checkups especially for the elderly since they are at high risk. The society should consider the visually impaired by offering them services that are easily accessible.

Reflect on key learning skills

The government should also put in place ways to assist the visually impaired for them to access treatment and other social needs with ease.  Everyone should learn to be cautious while treating people with disability since all are candidates of the same, they should be treated with love and should not be isolated.

Mary needs to be treated with care since this change needs some time to adjust and accept the present condition. This is a major life change which can affect Mary psychologically. She needs mental support besides physical support. The support will boost her self-esteem which might be compromised by the body image. Whenever I visit her, I will make sure that I assess the stoma’s status to ensure that it is in place and the right condition. Hygiene is critical in this whole process and needs to be observed for details. The skin should not be injured since these will give room to microorganisms. The peristomal sutures should be checked regularly just to be sure that everything is in place (Davenport 2015, p.14).

There are various appliances. If the appliance Mary is using is not fit I will provide a variety of other appliances to work with until we get the best appliance for her case. I will also provide templates that are appropriate depending on the size and shape of the stoma. She will require a waterproof pad which she will place under pouch to avoid soiling the bedsheets while changing the ostomy bag. I will also teach them how to renew the pouch, to take care of the skin by supporting the skin while removing the pouch to avoid tearing the skin which would create wounds. I will advise Mary on the various changes she needs to make regarding diet, for example, avoiding food with a lot of gas. Taking a lot of water to prevent constipation. I will let her know about rectal discharge which she might experience and might not be aware off, this will increase her preparedness of facing the situation. There physical activities which she might not be in a position to participate in like lifting heavy things, therefore, I should be in a position to accord her such assistance as she may need.

I will support Mary in maintaining her dignity by offering her a private place where we will carry out the procedure. I will make sure that the place is safe. Privacy will enhance her self- confidence so that she can follow up on the procedure (Bennett et al. 2015). I will assess her needs and guide her in selecting the right appliances. To be able to truck the process I will keep records for counter checking so that we can come up with the best appliance. Time to time I will review the selected appliance which will help us have the right information regarding the device and to select the appropriate stoma appliance. If Mary has soiled the linen, we will first remove the linen then change the pouch. I will first remove the soiled linen and under the pouch place a waterproof pad to prevent soiling of the bedsheets. I will then clean my hands with a disinfectant and gather the supplies. We will then together start carrying out the procedure of removing the pouch. This will increase her confidence. I will then wear gloves and remove the pouch. I will put the old pouching bag in a garbage bag. I will then remove the flange. With warm water, I will gently wipe the stoma and the peristomal skin. I will assess the stoma and the skin condition. I will change the pouch clean up the supplies and make sure that Mary is in a comfortable position.  In completion I will remove the garbage from her room and clean my hands and document the process: - the procedure, the stoma and the peristomal skin condition, the product used and her ability to tolerate and individually manage her condition (Whiteley et al. 2016, p.1192).

Issues to be aware of when attending to Mary’s care needs

 I will offer Mary practical support in managing her stoma; her age is affecting her ability to cope with the stoma. I will closely monitor her and identify the problems she is going through and offer the solutions. The most important thing is to assist Mary to become self-caring. This will go along way in giving her self-confidence and accepting the stoma. I will teach Mary and her carer on stoma management with which she will be sure that she can manage the stoma care at home independently. I will first seek a safe, and private place where she can be confident. Together we will agree to the teaching programme. I will share all the skills she requires and give her some referral notes should she forget something. I will give her counselling to support her psychologically and help her accept her new lifestyle positively (Gibson 2016). I will also talk with the family members and show them the need to treat Mary with love and avoid any behaviour that may undermine Mary because of her state.

Having a colostomy device is a significant life change. It requires the nurse and the patient devotion to cope with the major life change. There are chances of the patient living in self-denial if he/ she is not handled with care. The nurse needs to be patient enough to assist the patient cope and accept the life change. Extra precaution is required while treating a patient with a stoma, the need to be shown love and care for them to allow the new state of life and to fit in the society. The stoma needs to be handled with great care to avoid other infection which may be as a result of improper handling and exposure to microorganisms. It is fulfilling to see the patient succeed in accepting and changing her stoma with ease. The people taking care of the patient needs to have a positive attitude while caring for the patient since this gives the patient the courage to face life in the present circumstances.

Understand the orders given by the physician. Visit the patient and do an introduction and inform him of the bedbath procedure. Allow him time to release himself. Provide privacy and prepare the cabinet at the bedside to have enough space. Get the equipment and supplies ready. Have water in the basin at (110 – 115°F). Have ready hygiene articles. Get free clothing like a pyjama. Get linen if it will be of use. Have in place a portable screen. The hamper should be ready. Bring soap and soap to maintain hygiene. Have two clean bathing towels. Get ready for two bath clothes. Then nail file and comb to be fit to carry out the procedure. Bring disposable gloves and clean the hands and on the cabinet place the bath equipment (McConnell and Moroney 2015, pp. 991- 993).

My support to Mary for maintenance of her dignity as we collectively work on changing her colostomy device

Place the patient in the right position. Unclothe the patient carefully depending on her conditions and on the injuries he might be suffering.  Always place dip mitt and hand into bath water. Make sure to squeeze excess water. Start by washing the patient’s face and eyes. Start with the eyelids and use different portions of the clothing for each eye.  Clean the cloth and apply soap if applicable wash the face to the hairline then proceed to the ears and neck. Proceed to the upper limb clean the hands, under the armpits and apply deodorant and cut shot the nails. Wash the chest and abdomen. Proceed to the lower arm. Change the water and clean the washcloth and rinse, proceed to wash the back and the buttocks. Finally, clean the genitalia area and put the put the pyjama, replace any soiled clothing. Comb the patient's hair. Clean and store the bath equipment (Laerkner  Egerod & Hansen 2015, p. 201).

The observation will assist in determining the effectiveness of the treatment given. The comment will also serve as a guide to treatment. There may be changes in the skin presence of lesions, rashes, bruising which might be due to infection. The nurse will also notice the level of fatigue indicating the changes in his health condition; this will allow any assistance needed. The necessary support will be accorded if the problem is realised on time and more infection will be counteracted to allow for fast healing process (Stevenson 2016, p. 25).

To have effective communication, the nurse must understand the patient’s culture and handle him with dignity (O’hagan et al. 2014, p 1348). It’s essential to get information during the bed bath process, during the process the patient develops a close relationship with the nurse and therefore opens up to the nurse. The nurse should be able to get both verbal and nonverbal communication which will assist in the treatment process. The nurse will also have an opportunity to monitor the body movements and changes, therefore, recommending the right treatment. The nurse should document the observation to ease the process of reporting and to enhance the follow-up. With the written information it will be easy to observe the changes shown with the subsequent bedbaths and the patient's response to treatment.

Precaution needs to be observed to avoid injuries or infections. It’s important to avoid any escalation of the disease by being observant of the procedures being applied. I first cleaned my work area. The equipment were cleaned and rinsed ready for use since dirty equipment may pass microorganisms to the patient. The curtains were in place to protect the patient from cold. I used clean and warm water to maintain warmth. I had a soap dish to avoid placing it in water. The water was changed if dirty, cold or soapy. I only exposed the body parts that I was bathing.  I used a washcloth mitt to avoid dangling the ends of the washcloth. I washed her from the cleanest area to the dirtiest to avoid germs transfer. I used gloves to keep myself safe. 

The first thing is familiarizing with the patient. Introduce my presence and understand his needs, his medical history and then proceed with the process. The first step is informing the patient the procedure am intending to carry out. I then will gather the equipment that is a tissue, washbasin, a denture brush, and a denture container. I will then apply gloves and place towels under the patient’s neck. I will then ask the patient to remove the dentures and assist if the patient requires my assistance. I will then assess the patient oral cavity to check for the presence of caries, white patches or sore. If anything is observed I will document the observation (Webb, Whittle & Schwarz 2016, p.369).

The patient will remove the dentures and place them in a denture cup. I will provide the patient with a washcloth which will be used to clean the chin. I will then have a clean washcloth in the sink to hold the dentures if they happen to drop during the cleaning process. I will turn on clean cold water and clean all the surfaces with a soft brush and place them in a basin with water. I will rinse the denture cup, add cool water and place the denture in it. I will then provide the patient with water to rinse their mouth with a basin to spit in case they can’t move. In case the patient is using them immediately we will use an application powder to keep them in place, if not the will remain in the denture cup and place the cleaning tablet for soaking overnight. I will then clean all the items used in the process and dispose of the gloves (Villarosa et al. 2018).

I ensured that I was sensitive while communicating with my patient to maintain his self- confidence.  I allowed him to express his views and also speak of the challenges he may be facing. I encouraged him that he is not alone since there are other people who have lived long with dentures. He shared his experience, and I managed to give him more information regarding good care and maintenance of the dentures. I gathered the necessary information and handed the notes over to the dentist after completing the task and made all the clarification as required. The nurse notes were also provided for handing over.

My report will first have the patients name and the appropriate number. I would do the proper reporting by recording every step carried out and the time. I will record each step at a time together with the recommendation. This will allow enabling me to have the required information without losing some critical observations. In the report, I will include the date and the procedures carried out and the observations if any. With the report in place, it will be a natural process to track the patient’s progress. The report will be handed over to the appropriate person in the right time to allow the right action. If it involves different departments, the report will be available to the multiple departments.

It is important to consider carrying out the procedures in the right manner so that the health of the patient is maintained as the healing process continues. My equipment were clean to avoid bacterial infection. I applied gloves when carrying out the procedure. I observed all measures like using the right equipment for cleaning during the cleaning process to see that the cleaning is safe and perfect.  I used clean water free from germs in the whole procedure. I had denture application powder to keep the dentures in place.  I ensured that the dentures were adequately stored after the cleaning process if not in use. In completion, I cleaned all the items for future use, disposed of the gloves after the process to avoid contaminating the clean items.

References

Bennett, A., Wichmann, M., Chin, J., Andrews, J. and Bampton, P., 2015. Rural inflammatory bowel disease care in Australia: disease outcomes and perceived barriers to optimal care.

Davenport, J., 2015. A reflective journal: The diversity of stomal therapy nursing. Journal of Stomal Therapy Australia, 35(1), p.14.

Gibson, R.M., 2016. Bridging the gap between rhetoric and reality: can the law enforce quality patient-centred care in Australia?.

Kostyra, E., ?akowska-Biemans, S., ?niegocka, K. and Piotrowska, A., 2017. Food shopping, sensory determinants of food choice and meal preparation by visually impaired people. Obstacles and expectations in daily food experiences. Appetite, 113, pp.14-22.

Laerkner, E., Egerod, I. and Hansen, H.P., 2015. Nurses’ experiences of caring for critically ill, non-sedated, mechanically ventilated patients in the Intensive Care Unit: A qualitative study. Intensive and Critical Care Nursing, 31(4), pp.196-204.

Markus, H.R., 2017. In this together: Doing and undoing inequality and social class divides. Journal of Social Issues, 73(1), pp.211-221

McConnell, B. and Moroney, T., 2015. Involving relatives in ICU patient care: critical care nursing challenges. Journal of clinical nursing, 24(7-8), pp.991-998.

McLean, G., Guthrie, B., Mercer, S.W. and Smith, D.J., 2014. Visual impairment is associated with physical and mental comorbidities in older adults: a cross-sectional study. BMC medicine, 12(1), p.181

O'hagan, S., Manias, E., Elder, C., Pill, J., Woodward?Kron, R., McNamara, T., Webb, G. and McColl, G., 2014. What counts as effective communication in nursing? Evidence from nurse educators' and clinicians' feedback on nurse interactions with simulated patients. Journal of advanced nursing, 70(6), pp.1344-1355.

Peace, S., Katz, J., Holland, C. and Jones, R., 2016. The Needs and Aspirations of Older People with Vision Impairment. Touhy, T.A., Jett, K.F., Boscart, V. and McCleary, L., 2014. Ebersole and Hess' Gerontological Nursing and Healthy Aging, Canadian Edition-E-Book. Elsevier Health Sciences

Senra, H., Barbosa, F., Ferreira, P., Vieira, C.R., Perrin, P.B., Rogers, H., Rivera, D. and Leal, I., 2015. Psychologic adjustment to irreversible vision loss in adults: a systematic review. Ophthalmology, 122(4), pp.851-861

Stevenson, J.E., Israelsson, J., Nilsson, G.C., Petersson, G.I. and Bath, P.A., 2016. Recording signs of deterioration in acute patients: the documentation of vital signs within electronic health records in patients who suffered in-hospital cardiac arrest. Health informatics journal, 22(1), pp.21-33.

Tuohy, R., Stephens, C. and Johnston, D., 2014. Qualitative research can improve understandings about disaster preparedness for independent older adults in the community. Disaster prevention and management, 23(3), pp.296-308.

Villarosa, A.R., Clark, S., Villarosa, A.C., Patterson Norrie, T., Macdonald, S., Anlezark, J., Srinivas, R. and George, A., 2018. Promoting oral health care among people living in residential aged care facilities: Perceptions of care staff. Gerodontology.

Webb, B.C., Whittle, T. and Schwarz, E., 2016. Oral health and dental care in aged care facilities in New South Wales, Australia. Part 3 concordance between residents’ perceptions and a professional dental examination. Gerodontology, 33(3), pp.363-372.

Whiteley, I., Russell, M., Nassar, N. and Gladman, M.A., 2016. Outcomes of support rod usage in loop stoma formation. International journal of colorectal disease, 31(6), pp.1189-1195.

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