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Question:
Discuss about the Quality of Care and Migrant Workers Caring.
 
 
Answer:
Introduction

There is mounting evidence to establish the powerful and positive impacts that nursing creates on the lives of the patients (Hoeve, Jansen and Roodbol 2014, p.297). The spirituality and spirit that is expressed through nursing care gets reflected in the core of the organisational culture. The culture of caring is always illustrated by sound professional nursing practice that functions within an innovative environment, with the aim of improving patient and community health. High quality nursing care that is delivered to all patients in a healthy environment has been found to cure all health related economic struggles, with the help of better outcomes that are achieved at lower cost. Health care that encompasses nursing care is often influenced by the surrounding culture, although it constitutes the culture of its own. Caring is defined as the essence of nursing and this is often regarded as a moral responsibility, unique to nurses (Hesselink et al. 2013, p.e003416).

Caring is the innermost core of nursing, in addition to nursing cares planning. Caring culture has been defined in international nursing literature as a source of healing for all patients that is influenced by leadership. Caring cultures are also defined as those where there is a high regard for human dignity. A caring culture makes it imperative for nurses to not only develop, but also maintain a good spirit in their workplace. Creating a caring culture in the nursing workplace increases the well being of the clients and enhances job satisfaction as well, thereby increasing the rates of staff retention (Walsh and Shutes 2013, p.395). In other words, in nursing, caring culture can be defined as the context in which patients find places for their reconciliation. This report will illustrate the caring culture that exists within the gerontological nursing specialty, and will further recommend improvements to the caring culture.

Gerontological nursing refers to the nursing specialty that pertains to older adults. Gerontological nurses most often work in collaboration with people aged more than 65 years of age, their families and the entire community, with the aim of supporting the process of healthy aging and enhancing maximum functioning of the clients (Neville, Dickie and Goetz 2013, p.21).  This in turn leads to an overall improvement of the health wellbeing and quality of life of the older adults. Gerontological nursing is considered as an important nursing specialty that has shown success in meeting the health needs of aging population. Ageing population is often demonstrated by the shift in the distribution of population towards old age that is generally reflected in increasing the mean and median values of the population.  Owing to the fact that population ageing is widespread globally, and has reached an advanced stage in highly developed nation, gerontological nursing is of utmost importance to maintain the health of the older people. Due to a decline in fertility rates and longer life expectancy, the proportion of older population is increasing at a rapid rate. According to the World Health Organisation (2018) an estimated increase of older people from 605 million to 2 billion in the world, has been predicted between the years 2000 and 2050.

Furthermore, the proportion of the older adults continue to increase in more developed countries which is established by the fact that senior peoples comprised of 23% of the entire population of Japan in the year 2010 (Pew Research Center's Global Attitudes Project 2018). Gerontological nursing expects nurses to have appropriate skills in patient care, education, treatment planning, mental health, and rehabilitation. Gerontological nurses also take up different roles in their workplace, of which the main responsibility is focused on acting as caregivers. In addition to this primary role, gerontological nurses also out on the responsibility of counselors, educators, and advocates for their patients (Oyetunde, Ojo and Ojewale 2013, p.150). Gerontological nursing generally draws on knowledge that is focused on complex factors creating an effect on the health of older adults. Older adults exhibit an increase the likelihood, compared to their younger counterparts, from suffering from one or more chronic health disorders such as, cardiovascular disease, arthritis, diabetes, cancer, hearing impairment, dementia or visual impairment (Clegg et al. 2013, p.755).

 

The scope of practice for gerontological nurse requires them to work in variety of healthcare settings that includes nursing homes, acute care hospital, rehabilitation units, retirement home, assisted living facility, patient’s home, and community health agencies. Furthermore, the type of caring facility that is delivered to a patient depends on the conditions of the health of the gerontological patient. Gerontological nursing experts have considered older adults as the core business of healthcare. Presence of complex healthcare needs of the older population increases the likelihood of using healthcare services compared to younger people (Cheng et al. 2015, p.846). Creating a caring culture for the older population often involves demonstration of certain competency standards that encompasses incorporating professional attitude, expectations and values about mental and physical aging, in the provision of patient centred care, for the older adults and their families. Gerontological nurses also have the role of assessing risk factors for the older patients in understanding, receiving and giving adequate information, with the use of reliable and valid assessment tools.

Intervening to assist the older adults and support networks, with the aim of achieving personal goals that is based on an analysis of the community resources available and living environment, is another major attribute of this nursing specialty. Hence, it is the sole responsibility of the nursing professionals to value and listen to the older people, in addition to treating them with dignity, respect and compassion at all times (King, Roberts and Bowers 2013, p.274). Creating caring culture needs to be as important as a treatment planning, with a focus on understanding the particular needs of the older adults.

Evidence of analysis of findings

Gerontological nurses have special training in dealing with and showing care towards the elderly patients. It requires special skills to meet the myriad of challenges that are encountered while caring for the older patients (Steptoe et al. 2013, p.5799). An analysis of the observations and stories of the people receiving care suggests that adapting to the setting is one major problem encountered in gerontological nursing, due to the fact that the elderly patients reside in different environments. While some live at home, with their family members acting as caregivers, others are found to live in group homes, with other senior citizens. Some also live in assisted living facilities where they are capable of taking care of them and have minimal nursing care needs (Jang et al. 2014, p.645). An analysis of the observation suggests that problems are encountered, while ensuring presence of appropriate ambulation and mobility aids that are able to meet the needs of the patient. One significant challenge that can be deduced from reports of the carers and the service users is dying and death.

The older population is more prone to suffering from terminal illness, and face possibilities of death that creates emotional distress, not only for the patient and the family members, but for the caregivers as well. Research evidences state that nursing professionals go through different stages of grief and sorrow, and often fail to identify their coping mechanisms, while caring for terminally ill older patients (Boerner et al. 2015, p.216). They get subjected to feelings of guilt for not having the capability of ending the trauma that the older patients suffer from. Facing issues of dying and death also bring some feelings of mortality among the gerontological nurses, which in turn leads to depression and anxiety. The older population has often identified the need of obtaining compassionate and dignified care at the end of their life. All efforts related to providing a compassionate and caring environment seem futile, regardless of the impact of the nursing practice, when older patients suffering from terminal illness are being treated (Mendes 2014, p.1148).

Reports and observations suggest that gerontological nurses working with the aged population are more likely to experience compassion fatigue, in cases where they lack peer support, when compared to a strong and unified team. Such instances of compassion fatigue are also known as secondary traumatic stress, and characterized by a gradual lowering of compassion over the time, towards the clients (Neville and Cole 2013, p.351). Nursing professionals working directly with the aged population often exhibit symptoms related to compassion fatigue that includes stress, anxiety, sleeplessness, and pervasive negative attitude. This creates a detrimental effect on their work and they fail to provide a caring culture, for the patients being cared for which in turn leads to development of feelings related to self doubt, and incompetency. This has also been established by research evidences that have emphasized on the impacts of compassion fatigue in negatively affecting therapeutic relationship with the older patients. Such challenges make it difficult to develop a trusting and sympathetic relationship, thereby resulting in a failure of demonstrating adequate nursing skills, to reduce suffering of the older population.

 


It is also evident from direct observations of the service users that with an increase in age, the older population begins to suffer from more than one health ailments, and demonstrate severe pain and multiple aches in their body, which might be the action of the different drugs that are administered to them. There is mounting evidence which suggests the role of gerontological nurses in ensuring administration of proper medicines, to the patients and paying attention to possible drug interaction, which might create a toll on their health (Alomar, 2014, p.87). Therefore, demonstrating necessary skills that focus on adjusting medications and therapy prescription for the older patients facilitates the process of maintaining a caring culture. This is further been established by the fact that several researchers identified the disproportionate amount of prescribed and non-prescribed medications that are consumed by the elderly, which leads to alterations in physiology and places the population at a risk of developing significant drug interactions (Maher, Hanlon and Hajjar 2014, p.59).

Hence, it is imperative to the role of a gerontological nurse to monitor all kinds of clinically recognised or unrecognised drug interactions, thereby reducing chances of morbidity among the elderly patients. An analysis of the statements made by gerontological nurse also suggests that they have to spend more time with patients, when compared to their family members. This requires the nursing professionals to demonstrate empathy and patience during stressful times, with the aim of building positive relationship with the elderly (Chen et al. 2015, p.41). This in turn can be facilitated by respecting the needs or desires of the patient to the farthest extent, which in turn will facilitate the process of maintaining a caring culture. Prevalence of abuse and neglect have also been identified from the observations and findings that generally includes the inability of the family to handle complex care needs of the aging family members, presence of mental illness, or financial problems (Wangmo, Nordström and Kressig 2017, p.387). Further reports from the nursing professionals suggest that nursing shortage affects all aspects of their work and creates fatigue and burnout.

Research evidences established the fact that the developed countries are projected to experience shortage of nurses that will intensify with aging of the baby boomers and an increase in healthcare needs (Auerbach, Buerhaus and Staiger 2015, p.851). This demand for nursing professionals and the low nurse to patient ratio also contributes to increased risks of errors, which compromises the safety of all older patients and results in adverse outcomes or injuries. This in turn also results in greater cost for the healthcare system and the employers, and contributes to perceptions about unsafe working conditions. Hence, there is a need to recruit more nursing professionals which will allow the gerontological nurses to plan patient centred care, by considering the physical and mental health and wellbeing needs of the older adults and implementing the necessary changes to promote their safety and quality of life.

Effective workplace culture framework

Workplace culture in general encompasses the behaviours and values that contribute to unique psychological and social environment of a particular organisation. It represents the collective beliefs, values, and principles of the members of an organization, and also includes the vision and assumptions of the workplace (Shockley, Thompson and Andreassi 2013, p.310). The workplace culture existing in healthcare settings have been found to create major impact on the experiences of the patients of the service users, in addition to enhancing motivation, effectiveness, and commitment of the healthcare workers (Manley et al. 2011, p.2). Research studies suggest that any improvement in patient outcomes is generally influenced by positive characteristics of the workplace and adequate staffing. Hence, workplace culture in healthcare setting can be defined as the unit level culture, which is experienced by the staff and the patients each day. Nursing leadership been considered to be at the forefront of developing a positive workplace culture, in regions where the nursing professionals thrive (Tillott, Walsh and Moxham 2013, p.27).

 


Organisational structure, transparency, interpersonal relationship and effective communication are prevalent at a workplace. Researchers have also established the negative implications of patient outcome created by ineffective and toxic healthcare culture, which have been found to hamper the staff well being and results in wastage of valuable economic resources (Burke 2013, p.537). A healthy workplace culture has the potential of enabling nursing professionals to experience valuable learning at the workplace that would enable the provision of evidence-based care approaches. This would continuously improve patient safety, central for achieving optimal patient outcome. Fostering a transformational culture in response to an adaptation to changing healthcare context, based on fundamental core values, helps in empowerment and enhances the quality of patient care (Kirwan, Matthews and Scott 2013, p.254). Workplace culture is also influenced by the values and beliefs that are held by the practitioners, all of which focus on creating an atmosphere that promotes free learning from the past mistakes and emphasises on personal and professional growth.

Therefore, the major factors that will create a direct effect on development of an appropriate workplace culture include clarification of roles, which in turn will be promoted by presence of a transparent and flattened management that creates provisions for demonstration of leadership qualities and decision making skills (Bulger et al. 2013, p.489). Some of the essential attributes that help in governing presence of an effective workplace culture in nursing include trust, integrity, respect, appropriate communication, decision making skills, leadership capabilities, and teamwork (Manley et al. 2011, p.9). It is imperative for all nursing professionals to demonstrate willingness for engaging in a lifelong learning process that would enable them to utilise evidence-based practices while caring for the patients (Davis, Taylor and Reyes 2014, p.443). Taking into consideration the preferences and demands of the major stakeholders that includes the patient and the family members, in addition to forming an effective collaboration with healthcare professionals, coming from other disciplines, is imperative for maintaining safety of the patient and delivering optical healthcare services (Oshima Lee and Emanuel 2013, p.6). Realising all of the above values in practice, results in accomplishment of a shared vision of ensuring patient safety that is often driven by the needs of the service users. The role of a leader requires appropriate communication and enforcement of desired behaviour in the high stress profession of nursing, where in adequate staffing levels and workplace violence often results in heavy workload and fatigue among the professionals.

 
Recommendations

Establishment of a caring culture encompasses development of an environment where patients receive care services that are found to be safe, effective and person centred. Moreover, caring culture makes all the employees feel valued and supported. Over the years, there has been an increase in awareness on the impact of caring culture and the need for cultural changes in the area of health and social care (Shier et al. 2014, p.S7). Caring culture can be established by devising aims to achieve patient-centred an evidence-based care approaches that will be manifested through human flourishing, and an effective workplace culture in all healthcare situations (Melnyk et al. 2014, p.7). There is a need to divert attention at the micro system level where most healthcare services are provided and experienced by patients. Integrating work based learning with a due focus on active learning and formal systems will also enable transforming the existing culture in the nursing environment (Rathert, Wyrwich and Boren 2013, p.353).

Efforts must be taken to integrate creativity with cognition, with the aim of blending the heart, mind and soul energies, which in turn would enable healthcare professionals and nursing professional to free their thinking and emerge in all aspects (McFarland 2013, p.417). Development of healthcare action plans, through shared decision making that takes into account the opinion of all key stakeholders and exploring the beliefs and values of the patient being cared for, will help in agreeing upon a shared purpose. Enabling collaboration within the team and showing a commitment towards learning throughout the nursing practice, would also help in gaining momentum, thereby increasing the commitment to provide holistic care services to each patient (McInnes et al. 2015, p.1974). Further efforts must be taken for clarifying and communicating the purpose of treating aged care patients, in order to achieve the intended health outcomes (Ray and Turkel 2014, p.135).

Engaging all staff will help in creating a culture of caring, where the employees will feel empowered to take necessary actions that will facilitate their responsibility of caring for the patients (Bogaert et al. 2013, p.1719). It should be ensured that leadership skills are able to sustain a safety culture for all patients. Involving the governing bodies and safety organisations for coordinating and centralising oversight of patient safety will also promote presence of a caring culture in the healthcare setting. There is also a need to increase funding for research, related to patient safety, and implementation of evidence-based practices, to prevent all kinds of hazards that might arise while caring for an old patient (Nardi and Gyurko 2013, p.321). Supporting wellness of the healthcare workforce will also provide them the necessary motivation for providing safe care services to the patients. There is also a need to ensure implementation of safe and optimised technology that might prevent or minimise cases of unintended adverse health consequences.

Conclusion

To conclude, maintenance of the essential attributes of effective workplace culture will help in reducing or eliminating chances of abusive behaviour, opportunism and nepotism. Another way by which the current carrying culture is maintained in the context of gerontological nursing is by including all staffs in clinical decision making processes, which leads to fewer issues associated with the profession such as, compassion fatigue. The tone of the workplace culture is also established during on boarding and orientation. Highlighting information about the core values of nursing enables gerontological nursing professionals to articulate and display their personal values.

Hence, maintenance of these aforementioned attributes in the speciality of gerontological nursing helps the patients and their family members recognise willingness in caring for them and solving their health problems. It allows delivery of healthcare services in a patient centred way, by establishing partnership among the practitioners and the patients, to align decisions related to the needs, preferences and wants of the patients. These attributes will also result in empowerment of the nursing professionals, who display a commitment towards their profession and take all possible efforts to meet the intended goals and objectives.

 
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