Certificate IV in Ageing Support

Question: Discuss about the Certificate IV in Ageing Support. Answer: Responding to people from diverse cultural background: Situation 1- While providing support services to community, once I came across a person from ethic community of Australia. As he had different social and cultural beliefs about illness, I tried to understand his needs. Action 1- The person was not fluent in English and has his own dialect to communicate. I tried to understand his problem by non-verbal gestures and body language. While interacting with him, I was respectful towards him and gave him enough time to respond. I used indirect questions and also clarified whether he understood the meaning of the words. Outcome 1- It made the person comfortable and I got to know his problem. Situation 2- Once I provided support and care service to an aged Catholic who was depressed. Action 2- For me knowing about his problem which leads to depression was important to provide appropriate care and support. I asked him questions about his culture and personal history to examine difference in his culture from my own. I patiently listened to understand the conflicts in his life and situations leading to his current condition. Outcome 2- Appropriate relationship was established through listening and knowing about his cultural beliefs. Situation 3- Once I was involved in a group discussion where people from mainstream culture were dominating the discussion and people from minority culture remained silent. Action 3- I came to know that in some culture, it is customary for them to maintain silence for them before speaking. Women in ethnic minority groups do not speak up because their societies do not regard them as an important contributor of society. I held a personal meeting with the quieter people and encouraged them to speak. I also tried to ask what would make them comfortable in speaking. Outcome- 3- This meeting with the quieter people helped them to speak. Changes noticed within oneself Situation 1- Earlier I was not aware of diverse ideas about cultural difference in community. I judged people from my socio-cultural view point; however this course helped me to understand the diverse socio-cultural beliefs of people from different cultural background. This knowledge helped me in effectively interact with such people. Action 1- The change I find in me is that now I value and respect diversity of each cultural groups. I learned that people from different cultural background have their own style of communication and health beliefs. They take their action on those beliefs. I learnt how the migration experience affected their lives and attitude. The awareness about denial of different rights and exposure to violence helped me understand their needs in a better way and respond accordingly to make their lives better. Outcome- I achieved cross-cultural competence in dealing with such person. Safe work practices Situation- Action taken for workplace risk assessment Action- The following actions were taken to identify workplace risk: Examined past accident or risk in the workplace. Consulted employee about any safety issues or workplace hazards. Inspection and documentation of workplace environment by means of appropriate tool. Analyzed events that might take place due to presence of certain structure or process at the workplace. Evaluation of the severity of harm in different risk category. Outcome- Risk in workplace was identified and risk level rating helped in documenting required action to eliminate the risk. Work legally and ethically Situation 1- As a primary carer in hospital, a women came with serious head injuries for which she needed surgery immediately. However her husband died in the accident and she refused to sign the consent form unless informed about him. Action 1- According to National Competency standard for registered nurse, it is necessary to practice in accordance with legislation affecting nursing practice. According to legal requirement, without informed consent, surgery was not possible. The ethical code of non-malefecence and beneficence avoided me to inform patient about her husbands death. However I gave priority to the ethical code of autonomy so that patient knows about her husband and also gives consent for surgery. Outcome 1- Legal and ethical code for nursing practice was followed. Situation 2- Caring for an aged person as a community service worker. Action 2- As part of ethical principal and standard for aged care, my action needed to be consistent with professional values. I had to be loyal and responsible to avoid any conflict of interest in this group avoiding any harm was also a priority. Hence, while caring for them I indentified the risk and benefit of all intervention for the elderly people. The clients autonomy was balanced according to the best interest of client. Outcome 2- Care was provided within professional boundary. Situation 3- I faced ethical dilemma in community service when a young woman asked for help to arrange an abortion. Action 3- As a community worker, I believed right to life was important for all and I strongly discouraged the women and refused to help her. It was a conflict of interest situation and I avoided any ethical dilemma by stating my professional values do not support this act. Outcome 3- Professional boundary in care was maintained. Situation 1- Ethical dilemma of freedom versus control Action 1- A patient admitted to care service refused to eat due to the sufferings she was having due to her illness. As a carer, it was an ethical dilemma for me as I knew it may harm the patient. I could not force her too, hence I decided to compassionately explain her harmful consequence of avoiding meals and chances of further deterioration in her condition. Outcome 1- Ethical principle of autonomy and beneficence was maintained and patient was ready to eat. Situation 2- Ethical dilemma of truth telling and deception Action 2- A patient was diagnosed with cancer and her family members insisted not to reveal this to patient. However, this may challenge the autonomy and right of patient. I advised the family members that hiding truth may lead to more harm in the future. Outcome 2- Family members were ready to tell about the disease to patient. Situation 3- An elderly person came to the community service and he had diabetes. However, he had no control on his diet and binged on any food items. Action 3- To address the behavioral component of successful aging, the elderly persons lifestyle choices was an ethical dilemma for me. I discussed with him regarding the changes in body due to ageing and diabetes and how eating all types may harm him. Outcome 3- I managed to convince him regarding controlling his diet and leading a healthy life style. Workplace improvement Situation 1- The lack of hygiene at a care centre for aged was compromising the health and safety conditions of care seekers. Action 1- The staffs practices little hygiene and the premised was very dirty which could seriously harm elderly people with ailments. To maintain safety at work place, I took immediate action to train staffs regarding hygiene issues and all resource was provided to maintain cleanliness and avoid risk of infection. Outcome 1- Improvement in hygiene practice among staff was achieved. Situation 2- There was lack of coordination among staffs regarding their role and responsibility in social service and it was leading to many errors and chaotic situation. Action 2- To support good practice and maintain ethical principles, I arranged effective induction process for staff. The workload management included distributing written policy regarding role of social workers and protecting confidentiality of service users. They were made aware of the importance of alignment of service with social work values to maintain social justice. Outcome 2- Discriminatory behavior and inappropriate practice was addressed. Recognize healthy body system Situation 1- I came to know that a person was in severe depression after the loss of his husband and she hardly interacted with anyone. Action 1- Understanding the inner conflict and grief of the person, I gave her enough time and did not forced anything to her. I was very patient and tried to engage her in activities so that she temporarily forgets her sorrow. After she was comfortable with me, I slowly made realize her real worth in life and how she should aim for the future to make a better life. Outcome 1- It made the person overcome her depression and remove negative thoughts about worthlessness in life. Situation 2- I encountered a person with terminal illness who was in the last stage of his life. Action 2- In case of providing support to people with terminal illness, I shifted my care priorities. The main focus was on relieving pain and emotional distress in the person and maintaining their dignity in death too. I paid special attention to helpful interventions that eased the patients discomfort and helped him to connect with loved ones. Outcome 2- Respite care was achieved as it gave patient a break from the intensity of illness. Situation 3- Caring for elderly people with disability with gait. Action 3- I assessed the elderly person for the cause of gait disorder and found that it was due to arthritis. I arranged exercise program and physical therapy to improve balance, flexibility and muscle strength. Outcome 3- Exercise program helped in improving balance in the affected person. Provider support to people living with dementia Situation 1- Supporting people with dementia who struggle with judgement and finding words. Action 1- I tried to interact with the patient and used short words to avoid any confusion. It tried to give the patient appropriate environment such as well-lit room, clocks, calendars and familiar personal effects. In case the patient turned aggressive, I took care to shift the topic to acknowledge his feelings. In case of delusions, I tried to reinforce reality and provide support to patient. Outcome 1- The patient demonstrated congruent verbal and non-verbal communication. Situation 2- Supporting dementia patient who had difficulty in completing activities of daily living (ADLs). Action 2- First I monitored patient for his ability to perform ADLs and labeled patients cloth with name, address and telephone numbers. The patients food and fluid intake was monitored and assistance was given to patient during means. A bowel and bladder program was initiated to maintain continence and urine retention. Outcome 2- It gave the patient independence in self-care and management of ADLs. Reflection on conversation Situation- After the conversation with primary carer of people with dementia, they revealed challenges in providing person-centered care and providing appropriate recreational activities for them. Action- After this conversation, the affect was that I learned to take short break from caring to avoid burnout. Carers may also develop feelings of guilt, loss and anger. In that case, it is necessary to feel the pain and share it with counselors. Carers are often vulnerable to psychological morbidity and social isolation. Psychosocial interventions help to reduce the burden of care givers and build effective partnership with patients. Outcome- It helped in accurate patient care and providing stimulating environment to patients and carers. Facilitate empowerment of older people Situation 1- Used person-centered approach to care for older people Action 1- According to the standards of person-centered care, I have respected values of older people and passionately interacted with them to understand their physical, psychological and spiritual needs. I held the belief that flexible caring environment should be provide to older people where they are protected from all forms of physical, psychological, social abuse and violation of their rights. As they have many disability and health issues due to illness, they were regularly monitored and assessed for risk of infection, injury, imbalanced liquid volume, impaired verbal communication and many others. Outcome 1- Optimum health and well-being was achieved in older people. Situation 2- Adjusted communication for older people Action 2- Effective communication with older people becomes a challenge due to sensory deficits in them and gap in caring techniques of elderly patients and nurses. Generation gap also poses a problem due to different values and expectation of patient and care provider. The main action taken to overcome these challenges was to modify speech while communicating with elderly people. Altered pitch, touch and verbal expression were included in adjusting communication style with caring for elderly people. Outcome 2- It helped elder people to be satisfied with care given or provided. Situation 3- Assisted older people in necessary activities. Action 3- Cognitive intervention was provided to assist them in necessary life activities. The spatial perception of elderly was improved through memory training. It gave them stress management and memory self-efficacy support. They were given assistance in feeding, bathing and ambulating. Appropriate ambulatory support was provided to them to move without any assistance. Comfortable clothing was given and appropriate physical exercise according to their age was given to help in physical activities. Outcome 3- Elderly people achieved assistance in daily life activities. Situation- Adapting different communication styles to maintain positive relation with co-workers Action- To improve interpersonal relationship at workplace, I have adapted open communication style to discuss regarding issues in open platform. In case of written communication, I ensure that the language is simple yet explanatory so that reader understands my message instantly. To positively collaborate with co-workers, I try to provide correct information regarding work so that they do not have any issue or confusion regarding work. Assertive style of communication helped me to be active listener and negotiation any workplace conflicts. Outcome- Positive relation and team collaboration was achieved between co-workers. Situation- During caring for elderly patients, I tried to assess the client for any fall risk. Action- The assessment of fall risk in patient was done by means of multifactorial assessment. It helped to identify different fall risk factors and it included assessment of fall history, gait, muscle weakness, urinary incontinence, visual impairment, environmental hazards, cognitive impairment and medication review. It was done by appropriate fall risk tools. Outcome- Fall risk was identified and appropriate intervention was provided accordingly. Communicate and work in health Situation 1- Engaging in socio-cultural communication with people from different cultural background. Action 1- I made all attempts to understand the health and cultural beliefs regarding illnesss from these groups. This understanding helped in providing care according to their needs and preference. Outcome 1- Cultural competency in care was achieved. Situation 2- I engaged in culturally appropriate communication technique in addressing person from another culture. Action 2- I used different code of speech patterns and non-verbal communication techniques to establish rapport with the person. Before taking any action, I tried to listen and acknowledged their understanding about their personal issues. Outcome 2- Appropriate cooperative behavior was seen. Situation 3- I adapted different communication approach to manage conflict in community service. Action 3- I tried to listen to the opinion of each party and took honest feedback from them regarding challenges in community service. It helped in identify the area of problem and establishing credibility in the work process. Outcome 3- Conflict management in workplace was achieved. Communication barrier in workplace Situation 1- I faced communication barrier when a person from ethnic minority group was speaking in a different language which I did not knew. Action 1: I tried to understand the persons problem by his body language, hand gestures and non-verbal behavior. Outcome 1: I could interpret what the person wanted to say. Situation 2: I was discussing support options for a client who was a victim of domestic violence and the office environment such as noise and people walking by was acting as barrier in communication. Action 2: I moved to a much quieter place so that the client could concentrate and disclose his feelings to me. Outcome 2: The person was now paying attention to the discussion. Situation 3: I got a lengthy and disorganized message in community service and I was having problem in understanding what exactly I needed to do. Action 3: I paid more attention and whatever I understood I repeated it again to my coordinator to avoid any confusion. Outcome 3: I could overcome the problem in understanding message. Clarification of workplace instruction Situation 1: Instructing nurse regarding preparing a staff for surgery. Action 2: All pre-operation detail about the patient was given to the nurse and she had to assess the patient according to those parameters. She had the responsibility to get everything done one hour before surgery. Outcome 1: As instructed, the task was completed within set time frame. Situation 2: Instruction staff regarding supporting an elderly person in physical exercise. Action 2: All instruction regarding correct way of exercise was provided and he was asked not to over-exert himself to avoid any harm. A stop clock was given to him with duration of time to give for each exercise. Outcome 2: The instruction helped in maintaining accurate exercise routine. Support independence and well-being Situation 1: Care plan for balance disorder in an elderly patient. Action 1: It gave detail on multi-factorial assessment of patients and ways to conduct Timed Up and Go Test. Ambulator assistance was given to him to move at home independently and prevent injury. Outcome 1: The person was able to move independently for short distance. Situation 2: Care plan for elderly people with hip replacement surgery. Action 2: The instruction regarding physical therapy exercise helped me to support the client in contracting and relaxing certain muscles and teaching simple activities like sitting and bending. Outcome 2: It helped strengthen the hip and do slight movement by 1 week. Situation 3: Caring for elderly people in activities of daily living Action 3: Instruction regarding ADLs helped me support the person while bathing, dressing, moving and toileting. The patient was given the correct medicine and reminded about medicine on time. Outcome 3: The elderly people key need was met. Provide individualized support Situation: During my placement in health service, the senior nurse helped in supporting elderly in ADLs. Action: She gave me the idea that elderly people have many disabilities like low vision, hearing problem, balance and disorder problem and trouble in movement. She reminded me that never let them take medicine themselves as due to low vision they may take the wrong medicine. Furthermore she gave me all instruction regarding how to support them during feeding, bathing, dressing and toileting. Outcome: Support was given to client in ADLs. Palliative approach Situation- Caring for a cancer patient in palliative care. Action- I was emotionally drained and exhausted after experiencing the last stage of a person in front of my eyes. The suffering of the person each day made me depressed and I could feel the pain of their family members. Outcome- It brought me closer to the reality of death. Client receiving palliative care Situation 1- Assessment of medication in palliative care patient. Action 1- Only necessary medication was given and all unnecessary medication which may prolong suffering was avoided. Outcome 1- The patient suffering due to medication side-effect was reduced to some extent. Situation 2- Continuous assessment of symptoms and psychological needs of patients. Action 2- All attempts was made to maintain dignity in end stage of life. To meet psychological needs, all things were provided that gave the patient pleasure and happy time. Outcome 2- Prompt care was provided. Situation 3- Deactivation of certain medical device. Action 3- Cardiac defibrillator was deactivated to avoid pain and discomforts to patient. Outcome 3- Optimum care was provided. Issues during documenting arise for each of the client because with chronic illness, they presented many form of physical impairment and internal ailments. It was hard to keep track of care provided for different problems in the patient. Personal support needs Situation 1: Supporting elderly people in ADLs. Action 1: I was involved in assisting the elderly person in dressing, feeding, movement and toileting. I felt very positive when I could immediately respond to the need of the person and made sure that he did not have any hard time. Outcome 1: I gained confidence in assisting people in ADLs. While supporting the above person, I noticed a change in my attitude towards elderly. I was now aware about the changes in body due to aging and their disabilities made me a compassionate service staff. Relationship with carers and family members Situation 1: A patient with kidney problem Action 1: Family members were unaware about the dietary needs of patients with kidney ailments. I gave them diet instruction to avoid any problem. Outcome 1: Risk minimized Situation 2: An elderly person with diabetes. Action 2: The person was resisting controlling diet and his family members were asked to coax him to understand the importance of avoiding sweets to prevent further complication. Outcome 2: Physical needs during diabetes maintained. Situation 3: Supporting elderly people in physical exercise. Action 3: Their family members were also involved to make them understand the right way of exercise and correcting the person at home. Outcome 3: Effective physical exercise routine became possible. Action for situation 1: To maintain relationship with family members, they were asked to be patient with the patient and give emotional support to overcome health problem. Action for situation 2: The patient was made aware of his key responsibilities for his family members to avoid eating sweet dishes and control blood glucose level Action for situation 3: Family members were involved in care routine to build compassionate relation with elderly members Intervention for older people Situation 1: An elderly patient with balance disorder. Action 1: The patient was assessed for fall risk through Morse Fall scale. It helped in understanding the risk of fall. Based on the fall risk score, patient was given appropriate environment to prevent fall. Outcome 1: Fall risk minimized Situation 2: Patient with hip replacement surgery. Action 2: The pain level and movement of legs was monitored. Physical therapy was done to help the client strengthen hip muscle and develop their ability to ambulate. Outcome 2: Risk reduced due to physical therapy. Rights of client Situation- A patient with head injury was denied information regarding risk in surgery. Action- To protect the patients right and provide autonomy in care, I insisted all staffs that surgery cannot be done without informed consent. Outcome- Ethical and legal practice was achieved. Situation 1: Patient with hip replacement surgery. Action 1: The pain level and movement of legs was monitored. Physical therapy was done to help the client strengthen hip muscle and develop their ability to ambulate. Outcome 1: Risk reduced due to physical therapy Situation 2: A client was denied the right to autonomy in care and he wanted to know legal complaint process. Action 2: He was asked to fill the grievance form and drop a mail regarding the complain to manager of facility. He was asked to seek legal advice to proceed further. Outcome 2: Legal process explained. Legal and ethical compliance Situation Action Outcome A patient was denied the right to informed consent and the risk associated with surgery was not informed to her earlier. The situation was accurately analyzed to find all those person involved and who were responsible for breach of conduct. Strict actions were taken against them. Impaired practice in staffs due to alcohol or drug abuse Substance abuse places them at both personal and professional abuse. The dilemma was solved by teaching them the ethical principles of autonomy, justice, beneficence and non-maleficence. It led to practice according to ethical models of care. A nurse failing to exercise nursing care according to professional standard of nursing practice. The situation was analyzed and it was a case of negligence that lead to the incident. The nurse was penalized for the offence and use of mobile phones was banned in the premise. Aged Rights Advocacy Service- It provided guidance on rights of older people, how to identify abuse, take a plan of action and respond to elder abuse. Attached file- https://www.sa.agedrights.asn.au/residential_care/preventing_elder_abuse/policies_and_procedures Collaborative partnerships Situation Action Outcome I had worked with nurse to support elderly people. The nurse made me aware of changes in body due to ageing and how the environment around them was not suitable. It was creating risk of fall in them. Protective environment was provided to elderly person. My partnership with physical therapist. As we were working with older people with balance disorder, the physical therapist gave me the idea regarding appropriate exercise for them to improve quality of life. Appropriate physical exercise according to their needs was provided. My partnership with fall risk assessment team. They gave idea about the structure of premise that might increase risk of fall such as slippery tiles, rugs, spillage, pointed furnitures and many more. The environment around the elderly was modified to prevent them from any injury. To improve networking opportunities for service providers, coordination among them will be promoted and collaborative agreements will be disseminated among them. Networking through sharing newsletters or conference will in improving service. Collaboration will help to build trust and achieve goals together. Effective communication Situation Action Outcome A client gave the feedback that she was not happy with food and hygiene at the hospital. Inspection was done regarding how food was prepared and all process of hygiene at the facility was monitored All poor practice regarding cleanliness was addressed. An elderly patient at the health care clinic gave the feedback that the nurse was inattentive towards her and ignores her whenever she calls him during any problem. As a nurse it is their duty to continuously be available to their patients and provide compassionate care. The nurse was immediately called to know the reason for negligence and another nurse was arranged for the patient. The patients problem was solved. Feedback was taken from elderly people regarding the quality of service provided to them to assist them in ADLs. One of them gave the feedback that although the service was useful, however she could not independently ambulate in her home. Ambulatory device was given to her according to her needs Service improvement achieved. 2. Situation Action Outcome Written communication for rights of elderly. Written policy was prepared regarding rights of aged in the aged care such as legal rights, personal right, right to privacy and many others. Staffs followed this policy. Written instruction for code of conduct in aged care It gave detail on protecting the rights of aged person in care. Staffs became aware of ethical code of conduct Detail about home and community care program for elderly All detail regarding home care package and service package was written. Clients could choose service according to their needs. I faced challenge when a patient was unwilling to sign the consent form for surgery. She was very nervous and she was feeling that it will risk her life. She was informed that physician has carried out all medical assessment to prevent her from any risk and the surgery will benefit her and there is minimum chance of harm. As our hospital reported high rate of falls in patient in the past 6 months, a meeting was held with all staffs to discuss the reason for high fall rate. Based on this discussion, fall risk factors were identified and solutions were proposed to minimize the fall rate. Coordinate service for older people Situation Action Outcome Client with injuries due to fall Coordination with hospital and rehabilitation service was done to promote recovery of patient. Operations for fracture repair were carried out within 24 hours. Prompt action during fall injury became possible Coordinating service for stroke prevention An integrated stroke service was planned consisting of stroke prevention for people at risk, specialist for acute care and rehabilitation and long-term support to patients. It helped in health promotion and stroke prevention. Hospital care for elderly Hospital need was addressed in accordance with the stages of emergency response, early assessment, old age specialist care and care in medical wards. It helped to meet the needs of elderly people. Service planning and delivery Situation Action Outcome Planning of services for older people with disability The plan of action was to make support services easily accessible to these groups and engage in efficient consultation process. Support service access provided to elderly people with disability Planning for mental health in elderly people The plan was early recognition and management of mental health by accurate diagnosis. The service reviewed to assess individual care plan and assessment process. It led to promotion of mental health in aged care. Planning services to prevent fall in elderly Planning process regarding referring older people to appropriate service such fall service for assessment or to hospital in case of injuries. It helped to identify needs of prevention or treatment in patient.