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MN8411 Advanced Practice To Support Elder Health

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Question:

Learning outcome 1: Critically appraise discourse relevant to the care of the older adult population.

Learning outcome 2: Apply evidence based knowledge of elder health to enhance practice in a range of contexts in their own professional discipline.

Learning outcome 3: Critically reflect on their own practice in the care of the older adult population, making ongoing adjustments and improvements.

The focus of this assessment is to enhance your practice by applying evidence-based knowledge to your practice.  The aim is to allow you to reflect on current practice impacting on the care of the older adult population in New Zealand.

Task 1:

Identify a practice that has a negative impact on the experience of an older adult in a healthcare context.

When choosing a practice, you need to make sure that there is literature that discusses this practice.  

Task 2:

Tell us what currently happens in practice.

Task 3:

What does the literature suggest would be the optimal solution for this practice?

Task 4:

What does the literature suggest would be the optimal solution for this practice?

Task 5:

Based on the literature, describe how your own practice could be enhanced in the elder adult context in regard to your chosen issue.

 

Answer:

Introduction

There are 730000 aged or older adults are living in the New Zealand.
There are many concerns that the older adults experience while going through the process of aging (Ravenswood, Douglas & Teo, 2015).
Many of the aged populations are living with a variety of health adversities or complications
The residential aged care facilities provide safe and comfortable stay for the elderly members of the society.
The negative experience in the aged care can complicate the quality of life and lived experiences for the elderly (Ravenswood, Douglas & Teo, 2015).
This paper will focus on one negative experience, elderly abuse, and its impact.

Negative practice: elderly abuse 

  • Negative practice is any care activity which resulted in harmful experience or impact on the recipient
  • The elderly experience many negative practice outcomes which has perilous outcomes (Superseniors.msd.govt.nz, 2018).
  • The elder abuse is one such conspicuous example of a negative practice
  • As per the statistics, one in ten elderly individuals in New Zealand has gone through abuse (Superseniors.msd.govt.nz, 2018)
  • The instances of negative experience can occur in home, residential care facilities, and even in the hospitals  

Elder abuse and its impact

  • Elder abuse or abuse in general is any care activity that harms the elderly.
  • It can be extreme; but abuse can be subtle as well.
  • Both impacts the physical and metal health (Superseniors.msd.govt.nz, 2018).
  • Leads to physical injuries and various psychological impacts such depression, isolation, agitation, withdrawal and even psychosis in certain cases (Kaplan, 2018).
  • Although there are various conditions legislative and practice guidelines, the alarming situation is only escalating.

Types of abuse

  • There are various types of elder abuse
  • each type has a categorical impact
  • The first type is the physical abuse such as hitting, pushing, rough handling, over-medication, or inappropriate use of restraints or confinement (Nzherald.co.nz, 2018).
  • The second type is the psychological such as harassment, humiliation, threats, withholding decision making power.
  • The third type of elder abuse such as inadequate food, clothing, shelter, support, social contact, and health needs.
  • The last two types of common elder abuse are personal and institutional abuse.
  • Personal abuse is inappropriate touching or violating personal space.
  • Example of institutional abuse includes cultural or racial discrimination, inflexibility, and violation of rights and policies.  
 

Past experience of elder abuse

  • Elder abuse is a global problem
  • Most of the elder abuse cases are unreported, the exact figure is difficult to attain.
  • 10% of the aged New  Zealand population experience some form of abuse in community setting.
  • Negligence and psychosocial abuse is the most reported among other types of abuse.

Literature on abuse in care setting

  • One of the greatest origin of both physical and psychological abuse is the use of restraints or seclusion.
  • the rate of elder abuse reported from care homes carried out by care home workers is alarming (Nzherald.co.nz, 2018).
  • Instances such as taping shut the mouth of a woman as she had been making too much noise by a care worker has also been observed in Auckland.
  • Physically restraining the elderly, especially the elders with disability have been reported multiple times as well (Nzherald.co.nz, 2018).

Literature on abuse in care setting

  • pushing and shoving to ensure compliance is also notable instances of elder abuse in the aged care homes all across NZ.
  • Neglect has also been reported in the form of overdosing, inappropriate dosing and skipping to give medication altogether (Nzherald.co.nz, 2018).
  • verbal humiliation, discrimination, and lack of cultural safety, especially for the Maori is also a grave concern for aged care setting of NZ.

Contributors to the issue

  • Negligence, lack of compassion and noncompliance to code of conduct is the emerging themes as contributors
  • The workload, burnout and lack of proper training is the most important factor leading to unintentional abuse
  • For inflicting physical and psychological harm, the mix of unregulated health workers with trained regulated workers has raised concerns
  • Lack of cultural safety and appropriateness training in the staff is also a very important cause of cultural or institutional abuse

Evidence based solution

First and foremost, training and education of the existing aged care staff is key to addressing the negative practice of abuse
Institutional or in-house investigation team to monitor the care quality in aged care homes has been reported as a key intervention (Westermann et al., 2014).
Psychological counselling and financial support for the existing staff is a efficient technique for reducing negative impact of burnout
Recruitment and adequate training of culturally diverse staff from Maori or other such traditional backgrounds can address both staff shortage and lack of cultural safety (Miller, Beach & Thurston, 2018).

Evidence based solution

  • First and foremost, training and education of the existing aged care staff is key to addressing the negative practice of abuse
  • Institutional or in-house investigation team to monitor the care quality in aged care homes has been reported as a key intervention (Westermann et al., 2014).
  • Psychological counselling and financial support for the existing staff is a efficient technique for reducing negative impact of burnout
  • Recruitment and adequate training of culturally diverse staff from Maori or other such traditional backgrounds can address both staff shortage and lack of cultural safety (Miller, Beach & Thurston, 2018).

 Barriers in implementation

  • Lack of resources and infrastructure can be a grave issue
  • Lack of compliance among the existing or new staff
  • Lastly, lack of sufficient government and non government initiative or effort can not be ignored either in facilitating policy reform or establishing monitoring committees (Westermann et al., 2014)

Conclusion

  • Elderly abuse is a saddening issue in aged care
  • Both developed and developing nation represent similar concerns
  • Elder abuse in aged care settings range from physical, psychosocial, sexual to even cultural or institutional abuse
  • The workload, lack of training, burnout stress, and mix of regulated with non-regulated are biggest contributors to the abuse
  • Training, enhanced staffing and policy reforms with investigative committees can reduce the abuse rate improve the quality of life for elders.
 

References

Brook, G. (2017). Elder abuse and neglect: past endeavours as a springboard for the future. Aotearoa New Zealand Social Work, 20(3), 44-51.

Careerforce.org.nz (2018). Describe the use of enablers, restraints, and safe restraint practice in an aged care, health, or disability context. [Online]. Retrieved from https://www.careerforce.org.nz/wordpress/wp-content/uploads/WB26976v2.pdf [Accessed on 30th Oct].

Castle, N., Ferguson-Rome, J. C., & Teresi, J. A. (2015). Elder abuse in residential long-term care: an update to the 2003 National Research Council report. Journal of Applied Gerontology, 34(4), 407-443.

Castle, N., Ferguson-Rome, J. C., & Teresi, J. A. (2015). Elder abuse in residential long-term care: an update to the 2003 National Research Council report. Journal of Applied Gerontology, 34(4), 407-443.

Davey, J. A. (2016). Elder Abuse and Neglect. In A Restorative Approach to Family Violence (pp. 79-88). Routledge.

Kaplan, L. (2018). We need an integrated approach to elder abuse. Australian Ageing Agenda, (May/June 2018), 23.

MacKenzie, J. (2017). Alrc elder abuse inquiry: Recommendations for reform of aged care laws. Bulletin (Law Society of South Australia), 39(7), 36.

Miller, E., Beach, S. R., & Thurston, R. C. (2018). Addressing Intimate Partner Violence and Abuse of Older or Vulnerable Adults in the Health Care Setting—Beyond Screening. JAMA Internal Medicine.

Nzherald.co.nz (2018). Rest home abuse 'saddest thing in world'. [Online]. Retrieved from https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10519392 [Accessed on 30th Oct]

Nzherald.co.nz (2018). Twenty-one cases of elder abuse in NZ last year. [Online]. Retrieved from https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10519133 [Accessed on 30th Oct]

Nzherald.co.nz (2018). Twenty-one cases of elder abuse in NZ last year. [Online].. Retrieved from https://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10519133 [Accessed on 30th Oct].

Radermacher, H., Toh, Y. L., Western, D., Coles, J., Goeman, D., & Lowthian, J. (2018). Staff conceptualisations of elder abuse in residential aged care: A rapid review. Australasian journal on ageing.

Ravenswood, K., Douglas, J., & Haar, J. (2017). Physical and verbal abuse, work demands, training and job satisfaction amongst aged-care employees in the home and community sector. Labour & Industry: a journal of the social and economic relations of work, 27(4), 302-318.

Ravenswood, K., Douglas, J., &Teo, S. (2015). The New Zealand aged care workforce survey 2014. Auckland: New Zealand Work Research Institute. Retrieved September, 14, 2015.

Superseniors.msd.govt.nz (2018). Elder Abuse in New ZealandRetrieved from https://www.superseniors.msd.govt.nz/elder-abuse/

Westermann, C., Kozak, A., Harling, M., & Nienhaus, A. (2014). Burnout intervention studies for inpatient elderly care nursing staff: systematic literature review. International journal of nursing studies, 51(1), 63-71.

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