Nursing is a profession that requires one to spend every working day communicating with people and helping them live healthy lives. However, nurses also make many decisions and perform procedures that may make patients uncomfortable or confused. In some environments, the line between care and the lack of autonomy may be thin. One of these settings is aged care, where older individuals may spend significant periods of time. Due to the increasing quality of life in many countries, more older people enter aged care (Eagar et al., 2019; Khadka et al., 2019). Longer lives also mean more health complications and a desire to maintain one’s autonomy and mobility (Nilsson et al., 2019). In this case, nurses take on more than medical procedures – they provide a service that affects older adults’ daily lives. Thus, it is vital to approach the delivery of aged care with such principles as patient-centered care, respect, and dignity.
Nurses’ Contribution
The idea of “caring” may be viewed as inseparable from nursing and healthcare in general, but understanding it is essential for nurses when working with older persons. When nurses care, they regard patient needs as the foundation for all activities (Forbes et al., 2018). This means not only including and performing the procedures that patients require but acknowledging their right to refuse certain treatments.
Respect and dignity are also related to this requirement and should be included in nurses’ training. Patients’ autonomy and ability to decide for themselves protect their dignity and individuality (James, 2018). Registered nurses have to support older adults’ freedom of choice when they enter aged care. Otherwise, patients’ autonomy is taken away, which goes against one of the foundational nursing principles, along with justice and nonmaleficence (James, 2018; Seedsman, 2019). To show respect, nurses should acknowledge older individuals’ life experiences and treat them not as children in need of care, but adults with rights and freedoms. It is vital to refrain from assuming one’s capabilities and limitations.
Healthy Aging
Healthy aging implies that an older person’s wellbeing is supported continuously, while prevention and management are prioritized over treatment and mitigation, if possible. According to the World Health Organization (2020), it is the preservation of older adults’ “functional ability,” and it encompasses decision-making, learning, contributing, building connections, and fulfilling one’s basic needs (p. xiii). Therefore, healthy aging requires people to have a high degree of autonomy over their lives. This principle is foundational when considering how nurses should approach their duties. The notion of person-centered care is a part of ensuring healthy aging. When adhering to the principles of person-centered care, nurses account for patients’ wishes before deciding on procedures and treatments. Communication is a staple of this model, as the nurse has to ask the patient about their needs and explain how they can be fulfilled with the help of nursing care.
Similarly, dignity is another part of helping older people sustain a high quality of life in aged care. Referring to the principles of functional ability, dignity plays a role in people’s ability to learn and make decisions. Moreover, for some individuals, mobility and meeting basic needs are also tied to dignity – nurses have to respect people’s decision to use or not use mobility aids while utilizing their knowledge and expertise to ensure patient safety.
Respect is a basic need directly linked to people’s self-image and place in society. Healthy aging includes building relationships, and respect plays a significant role in keeping these connections. By showing respect, the nurse acknowledges their autonomy and individuality and creates a positive environment. Furthermore, respecting one’s wishes is a part of person-centered care outlined above. The three ideas are intertwined and require the nurse to remember the patients’ right to contribute to care.
Examples
Many examples of evidence-based nursing interactions that support patients’ dignity and autonomy in aged care exist. One of the major parts of senior care is helping people with dementia and similar conditions that restrict patients’ ability to be fully self-supportive. In this case, nurses support the patients’ dignity by creating a supportive relationship with the patient rather than taking over their activities (Pennbrant et al., 2020). Learning about approaching dementia and acquiring skills to help patients without restricting their ability to decide is a necessary part of nurses’ training (Bauer et al., 2018). As Pennbrant et al. (2020) and Bauer et al. (2018) note, it is challenging to provide care without this expertise. Therefore, expanding one’s skillset is a part of patient-centered care.
Another common part of aged care that may cause patients mental and physical distress is continence. The issue of incontinence is a problem that is not only uncomfortable and painful for patients – it is also stressful and taxing mentally (Ostaszkiewicz et al., 2018). Nurses can support the patients’ dignity in many ways to ensure that continence does not become an issue that stops older individuals from enjoying their daily activities. For instance, patients should have enough privacy and be able to communicate their continence care preferences (Ostaszkiewicz et al., 2018). Nurses must approach this subject with the patients’ emotions in mind, as some individuals perceive this problem as shameful or undignified. Furthermore, it is vital to focus on timely and preventive care to avoid significant pain and distress.
Conclusion
Older individuals entering aged care find themselves in a new environment, where healthcare providers may influence their freedoms and abilities. Registered nurses significantly contribute to patient experiences in senior care. Their duties expand beyond performing procedures as they build connections with patients and manage their daily lives. Therefore, the caring process must rely on patient-centered care principles, dignity, and respect. These aspects of care are essential for supporting older individuals’ autonomy, mobility, and social needs.
References
Bauer, M., Fetherstonhaugh, D., Haesler, E., Beattie, E., Hill, K. D., & Poulos, C. J. (2018). The impact of nurse and care staff education on the functional ability and quality of life of people living with dementia in aged care: A systematic review. Nurse Education Today, 67, 27-45.
Eagar, K., Westera, A. B., Snoek, M., Kobel, C., Loggie, C. L., & Gordon, R. (2019). How Australian residential aged care staffing levels compare with international and national benchmarks. Australian Health Services Research Institute.
Forbes, V., Harvey, C., & Meyer, A. (2018). Nurse practitioners in aged care settings: A study of general practitioners’ and registered nurses’ views. Contemporary Nurse, 54(2), 220-231.
James, T. A. (2018). Setting the stage: Why health care needs a culture of respect. Harvard Medical School.
Khadka, J., Lang, C., Ratcliffe, J., Corlis, M., Wesselingh, S., Whitehead, C., & Inacio, M. (2019). Trends in the utilisation of aged care services in Australia, 2008–2016. BMC Geriatrics, 19(1), 1-9.
Nilsson, A., Edvardsson, D., & Rushton, C. (2019). Nurses’ descriptions of person-centred care for older people in an acute medical ward—On the individual, team and organisational levels. Journal of Clinical Nursing, 28(7-8), 1251-1259.
Ostaszkiewicz, J., Tomlinson, E., & Hutchinson, A. M. (2018). “Dignity”: A central construct in nursing home staff understandings of quality continence care. Journal of Clinical Nursing, 27(11-12), 2425-2437.
Pennbrant, S., Hjorton, C., Nilsson, C., & Karlsson, M. (2020). “The challenge of joining all the pieces together”–Nurses’ experience of palliative care for older people with advanced dementia living in residential aged care units. Journal of Clinical Nursing, 29(19-20), 3835-3846.
Seedsman, T. (2019). Aging, informed consent and autonomy: Ethical issues and challenges surrounding research and long-term care. OBM Geriatrics, 3(2), 1-1.
World Health Organization. (2020). Decade of healthy ageing: Baseline report [PDF document].