More Nurse Cases in Elderly Care

Registered nurses can and should make a difference in the quality of care in residential geriatric care facilities, writes Dr. Joan Ostaszkiewicz.

Residential geriatric care facilities need to hire more registered nurses (RNs) to work directly with residents if they are serious about improving the quality of care.

Residential geriatric care facilities with a high proportion of RNs qualified for aging or geriatric care have reduced pressure injuries, reduced use of restraints, reduced chances of hospitalization, reduced complaints, and increased incidence of urinary tract infections. Is associated with a reduction in mortality and mortality. Nursing Economics $ 2015 showed.

Despite such evidence, the 2016 National Elderly Care Workforce Survey and Survey found that RN was only 15% of the workforce of Australian residential elderly care facilities and the ground was thin. I did.

The role of registered nurses in home care has also changed. Once they applied their clinical skills to resident care, they are now in managerial positions and struggling to provide the necessary clinical oversight as well as direct care.

Where they worked directly with other nurses at the care level, they are now responsible for delegating care delivery to an unregulated workforce, but remain responsible for the quality of care. Few RNs want this high-risk situation.

The public needs to be more concerned about the potential impact on the health and safety of its inhabitants.

Lack of clinical nursing knowledge at the direct care level leaves conditions such as diabetes out of control and increases the risk of resident death.

That means that the drug is given without considering whether it is appropriate in the given situation. The side effects of the dosing regimen are not monitored and are not promptly addressed. Residents are also at risk of developing an unspecified or untreated acute condition, such as delirium.

Inadequate numbers of well-educated RNs in residential geriatric care facilities also mean that there is a high risk of mutual contamination in the COVID-19 situation.

Nurses find themselves involved in a greater conflict of debate about the best ways to address the complex care and service needs of older people in home care.

On one side of the debate is the approach to care that privilegedly gives residents the need for social care, the need for social interaction, and allows them to play a more complete role in society. There are advocates. This privilege does not recognize the complexity of the resident’s clinical and medical needs.

People in need of care in residential geriatric care facilities have a high rate of chronic health conditions such as diabetes, Parkinson’s disease, dementia, stroke, heart disease, respiratory illness, depression, kidney damage and incontinence. ..

They are becoming older, more vulnerable, have more complex health needs, and require interdisciplinary services that derive from the overall care of the elderly, health and the disabled.

Almost 40% of older caregivers exhibit 1-3 behavioral changes and / or psychological symptoms, most commonly agitation, followed by hypersensitivity and anxiety. 22% are unable to perform mobility-related tasks and 50% fall within 12 months.

In addition, a recent analysis of data from the Australian Institute of Health found that 77% of elderly caregivers experience urinary incontinence at least three times daily and 34% experience fecal incontinence at least four times a week. Became clear.

Another lesser-known fact is that 23% of residents die within a year of admission and half die within two years.

All of these factors should indicate a need for skilled nursing and medical care.

Market-oriented policies have played a key role in the evolution, structure, and resources of elderly care. Market interest has successfully sold the lie that home care for the elderly is a lifestyle choice. Residents are consumers who have access to help and services whenever they need them in a hotel-like environment.

However, the Royal Commission’s findings on the quality and safety of elderly care published in its interim report suggest that this is far from people’s actual experience. Residential geriatric care facilities are not an accommodation choice. Access is through an assessment process based on human health and well-being needs.

The government was unable to address the concerns outlined in the previous review. We are now in a very dangerous situation where the knowledge and skills of the workforce are not keeping up with the growing clinical and medical needs of the population.

A pandemic has taken to reveal the over-reliance of the elderly care sector on an unregulated workforce that is not educationally prepared for the complexity of resident’s changing clinical care needs.

This is a direct result of government policy and negligence. In most cases, it does not determine the character of a personal care worker who is doing his best in an environment where RN is absent and therefore lacks clinical governance.

Compassionate attitudes, hotel-type service skills, and all goodwill around the world do not replace the knowledge that is part of RN’s education.

Registered nurses minimize the risk of aging processes, how to identify signs and symptoms that need further attention, falls, pressure injuries, incontinence, delirium, and functional deterioration, and prevent the spread of infections I am educated about how to do it. Prevention and management of these conditions is RN’s core competency.

In recent years, nurses have had to defend the role of nurses in home care and demonstrate their clinical and cost-effectiveness. We struggle to do this due to methodological, definitive, and cultural challenges and the lack of high quality randomized controlled trials.

Therefore, in its submission to the 2011 Productivity Commission’s Survey on the Care of Elderly Australians, the Australian College of Nursing stated that “the quality of resident care is a simple mathematical ratio of staff to the resident who is assigned. It should not be reduced to. ” This was followed in 2016 by the publication of a white paper arguing that nurses are essential to reforming health and elderly care.

Nonetheless, elderly care providers and governments have firmly adhered to the claim that there is no solid evidence of a link between staffing and quality of care.

This claim is simply wrong. The quality of elderly care is affected by multiple factors. The first is the number of RNs available and their eligibility.

Dr. Joan Ostaszkiewicz is Director of Aging Care Research at the National Institute on Aging.

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