Assignment - Medical / Nursing tutors only

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Older people in Australia

Australia has an ageing population

There are approximately 4000 people, over 100 years of age currently living in Australia

The fastest growing segment of the population is the 85yrs + group

Many of these people still live independently, however some also live in permanent residential aged care communities (2015: 51,025 males and 114,778 females – ABS)

While older people are frequent users of health care services, a recent government report noted that while half of older people have some degree of disability, three-quarters reported their health as good, very good or excellent (Older Australia at a glance)

https://www.aihw.gov.au/reports/older-people/older-australia-at-a-glance/contents/health-and-aged-care-service-use/aged-care

Task context

People aged 65 years and older constitute 50% of health service users. As people age, they experience changes to their physical and mental function, and can experience many social changes in terms of family and career. For those requiring health services, these changes are further complicated by illness (Moyle, et al., 2014).

Source: North Shore Family Chiropractors Chatswood

Task aim

The aim of this assignment is to apply the theoretical knowledge gained from modules 1 and 2 of this course to a case study that you have encountered in a Bachelor of Nursing clinical placement. Examples of case studies may include (but are not limited to) the range of prevalent conditions examined in module 1 and 2:

Falls and fractures

Incontinence

Delirium

Alzheimer’s Disease and other dementias.

Source: Caritas Social Action Network

Task Instructions

You will need to describe the issues in your case study, and then undertake a process of analysis in order to generate a comprehensive nursing plan of care. Practising this process of analysis will help you to feel more confident in providing nursing care to an older person in the clinical setting.

Your case study must:

Reflect upon the impact that various stereotypes of older people may have on the older person and their nursing care;

Recommend the nursing requirements for older people diagnosed with, or at risk of, complex health conditions and/or cognitive decline; and

Evaluate the outcomes for nursing care of older people.

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Show Editing and proof-reading checklist

So what is required?

For this task you need to prepare a 2500 word written assignment in a case study format.

There are two parts to this assignment.

Part 1 is a case study (750 words) and

Part 2 is a plan of care for the person (1750 words).

Writing your case study – 750 words

Case studies require you to demonstrate the skills of observation, analysis, problem solving, together with an understanding of ethics and professionalism. They should be written in formal, professional language.

This might include:

Background to the case – the individual and what has happened that is of concern.

Your observations: not only what is going on but why, how, when and who is affected?

What the experts have to say about this topic. Do your observations align with theories on this topic or not? Explore the similarities and differences.

What are your conclusions?

PART 1 : Case study 750 words

Introduce the purpose of the case study.

Briefly outline the main problems as you recall and reflect on the care of an older person (over 65 years or over 55 years if Australia’s First Peoples) who has at least two (2) co-morbidities which impact on their functional status in an acute care (hospital) setting.

Write a case study based on this experience. In the case study:

describe the impact that specific stereotypes of older people may have on the person, and

identify a specific, and recent environmental change impacting this older person.

PART 1: Where to start?

Step 1: Think about your nursing placement experiences

Step 2: Choose a person (65yrs+ or 55yrs+ if Australia’s first peoples)

Step 3: Do they have at least 2 co-morbidities which impact on their functioning?

Step 4: Were they in a hospital setting / Acute care?

Step 5: What stereotypes of older people did you notice?

Step 6: What impact did these have? (On the person? On their care?)

Step 7: Were any assumptions made about them? (eg capacity, mobility, pain experience etc)

Step 8: What has changed in their environment recently?

Step 9: Build a case study around them.

Take a break between when you finish writing and commencing editing.

Create the case study

Who are they? (Base on real experience)

What is their scenario? And Health status?

What is their background? Family situation? Working life?

What co-morbidities do they have? What does the literature say about these co-morbidities in older people?

What is important to be aware of in the combination of these conditions, and their age, and their scenario?

How did their environment change?

What aspects of their care impacted them in a positive or negative way?

Why do you think these occurred?

Library and Learning Services – Learning Adviser presentation

Suggestions on how to write the case study – 750words

Paragraph 1- 250 words (Who is this person?)

Introduce the purpose of the case study

Describe the person, background, current situation

Identify their main health problems

Paragraph 2 – 250 words (What issues are leading to their complex health status?)

Specifically discuss at least 2 co-morbidities and how they affect this person, and why their situation is complex

Paragraph 3 – 250 words (What other external influences are impacting their wellbeing?)

Discuss the impact of stereotyping in the diagnosis, treatment and caring of the older person

Outline a specific, recent environmental change which has impacted this older person

Source: La Roche-Posay

PART 2: Care plan (1750 words)

Develop a plan of care for the person.

In your plan you must:

Identify and justify the top five objectives for nursing care,

Describe and justify evidenced-based nursing interventions to achieve each objective, and

Create and describe the evaluation criteria that you will use to judge whether the plan addressed the identified objectives.

Throughout your care plan it must be clear how your decisions have been informed by a critical analysis of the case, applying concepts (stereotypes, nursing requirements, outcomes) raised in modules 1 and 2.

No fewer than 10 different sources from the scholarly literature should be sourced.

NOTE: It is important that you maintain confidentiality as per University guidelines and include no identifying demographic information about patients, colleagues or institutions.

PART 2: Care plan (1750 words)

Library and Learning Services – Learning Adviser presentation

Ask yourself:

Based on the case, make a list to identify all their health needs.

How do you know these are accurate / appropriately diagnosed?

What assessments have already taken place?

What aspects of stereotyping may have occurred?

…and then ask yourself:

Which 5 health needs objectives are the most important to this particular case? Why?

Which 5 nursing interventions can meet these needs, now and in the immediate future? Why have you decided this?

Nursing Times

Take a break between when you finish writing and commencing editing.

PART 2: Research for best practice

Library and Learning Services – Learning Adviser presentation

Ask the literature (and take notes):

Look for each health need in relation to older people in Australia.

What interventions are suggested or possible?

What nursing care intervention is most appropriate in this case?

Why? What does the evidence tell us?

What stereotypes must you be aware of in each intervention?

How will you test to see if the intervention has been successful?

What measure will you use?

What impact will this intervention have on the health status of the person you are caring for?

Take a break between when you finish writing and commencing editing.

Planning Activity – keeping clear notes

Try to link your ideas and evidence to show connections

The case: 2 co-morbidities	Health Needs	Nursing care Interventions	Evidence and literature	How will you evaluate each intervention?
1.	1.	1.		1.
2.	2.	2.		2.
Scenario	3.	3.		3.
Background	4.	4.		4.
Details	5.	5.		5.

Academic Literature

What stereotypes may effect each step of their care?

See next slide for example of this. Students insert their own topic (health risk) and pose their own question in line with the health risk being investigated.

Planning Activity - example

Try to link your ideas and evidence to show connections

The case: 2 co-morbidities	Health Needs	Nursing care Interventions	Evidence and literature	How will you evaluate each intervention?
1. Heart arrhythmia	1. Pain	1. Pain scale and medication adjust	Arnold & Goi, 2014	1. Reduced pain scale reported
2. Back pain	2. Pressure Injury	2. 2hr rotation		2.
Male, 64, retired, BMI 40, Medication for heart condition, Depression	3. Depression	3. Interdisciplinary team, social network	Rogers, 2016 p.10 Smith, 2017 p.56	3. Self reporting, Depression test scale improvement,
Widower, daughter	4.	4.		4.
Golf, Walking	5.	5.		5.

Academic Literature

What stereotypes may effect each step of their care?

See next slide for example of this. Students insert their own topic (health risk) and pose their own question in line with the health risk being investigated.

PART 2: Possible approach to Writing the Care Plan – 1750words

Intro (150 words) – Why an individualised, evidence based care plan for nursing is essential for achieving positive health outcomes. Comment on who is being cared for. What will be covered in this plan. Why implementing and evaluating best practice care will assist this person in their quality of life and/or health status.

Body: (1500 words) Each Health need is then discussed and includes: A & P and Pathophysiology, Best Practice Intervention, Evidence from Literature, Reasoning for choice of intervention, Comments on impact of possible stereotyping, Evaluation measures.

Health need 1 – 300 words

Health need 2 – 300 words

Health need 3 – 300 words

Health need 4 – 300 words

Health need 5 – 300 words

Conclusion (100 words): Summarising the key issues, restating why this care plan will be effective with a final comment on the condition and stereotyping of older people in nursing.

Take a break between when you finish writing and commencing editing.

PART 2: Sample paragraph

Although pain is known to be common in all post-operative patients (Arnold & Goi, 2014; Riff & Trussier, 2016) there is minimal information about the patient’s pain experience among hospitalised older patients. Available evidence suggests that pain treatment for older adults is often poorly assessed and administered, largely due to stereotyping of older adults as ‘cranky’ or ‘grumpy’ (Gamble et al., 2009). Moreover, recent evidence suggests that during the hospital stay, pain severity is often left unrecorded and unattended to (Zorg et al., 2014), leaving older patients in pain, hindering their recovery process. A specific nursing intervention which can be easily implemented is pain scale measuring. Blake and Fisher, (2017) argue that regular checks where patients reflect their pain level on a scale of 1 (very low pain) to 10 (extreme pain) can be carried out hourly, when needed, without incurring any extra cost to the hospital or specialised training of staff, and thus should be made a mandatory part of any care plan. In Mr Blackburn’s case, his unattended pain resulted from the nursing staff labeling him as ‘a complainer’ or ‘a pain in the butt’. This stereotyping by nursing staff led not only to the patient’s discomfort, but increased his depression and sense hopelessness, which in turn extended his hospital stay. These negative consequences of Mr Blackburn's care resulted in poorer health outcomes incurring economic, social and emotional costs, which could have been avoided had the pain measuring been seen as ‘standard practice’ and accurate records of Mr Blackburn’s pain levels been kept. (255 words)

Take a break between when you finish writing and commencing editing.

Sample paragraph: Structure

Although pain is known to be common in all post-operative patients (Arnold & Goi, 2014; Riff & Trussier, 2016) there is minimal information about the patient’s pain experience among hospitalised older patients. Available evidence suggests that pain treatment for older adults is often poorly assessed and administered, largely due to stereotyping of older adults as ‘cranky’ or ‘grumpy’ (Gamble et al., 2009). Moreover, recent evidence suggests that during the hospital stay, pain severity is often left unrecorded and unattended to (Zorg et al., 2014), leaving older patients in pain, hindering their recovery process. A specific nursing intervention which can be easily implemented is pain scale measuring. Blake and Fisher, (2017) argue that regular checks where patients reflect their pain level on a scale of 1 (very low pain) to 10 (extreme pain) can be carried out hourly, when needed, without incurring any extra cost to the hospital or specialised training of staff, and thus should be made a mandatory part of any care plan. In Mr Blackburn’s case his unattended pain resulted from the nursing staff labeling him as ‘a complainer’ or ‘a pain in the butt’. This stereotyping by nursing staff led not only to the patient’s discomfort, but increased his depression and sense hopelessness, which in turn extended his hospital stay. These negative consequences of Mr Blackburn's care resulted in poorer health outcomes incurring economic, social and emotional costs, which could have been avoided, had the pain measuring been seen as ‘standard practice’ and accurate records of Mr Blackburn’s pain levels been kept.

Main point

Take a break between when you finish writing and commencing editing.

Sample paragraph: Structure

Although pain is known to be common in all post-operative patients (Arnold & Goi, 2014; Riff & Trussier, 2016) there is minimal information about the patient’s pain experience among hospitalised older patients. Available evidence suggests that pain treatment for older adults is often poorly assessed and administered, largely due to stereotyping of older adults as ‘cranky’ or ‘grumpy’ (Gamble et al., 2009). Moreover, recent evidence suggests that during the hospital stay, pain severity is often left unrecorded and unattended to (Zorg et al., 2014), leaving older patients in pain, hindering their recovery process. A specific nursing intervention which can be easily implemented is pain scale measuring. Blake and Fisher, (2017) argue that regular checks where patients reflect their pain level on a scale of 1 (very low pain) to 10 (extreme pain) can be carried out hourly, when needed, without incurring any extra cost to the hospital or specialised training of staff, and thus should be made a mandatory part of any care plan. In Mr Blackburn’s case his unattended pain resulted from the nursing staff labeling him as ‘a complainer’ or ‘a pain in the butt’. This stereotyping by nursing staff led not only to the patient’s discomfort, but increased his depression and sense hopelessness, which in turn extended his hospital stay. These negative consequences of Mr Blackburn's care resulted in poorer health outcomes incurring economic, social and emotional costs, which could have been avoided, had the pain measuring been seen as ‘standard practice’ and accurate records of Mr Blackburn’s pain levels been kept.

Main point

Reasoning

Take a break between when you finish writing and commencing editing.

Sample paragraph: Structure

Although pain is known to be common in all post-operative patients (Arnold & Goi, 2014; Riff & Trussier, 2016) there is minimal information about the patient’s pain experience among hospitalised older patients. Available evidence suggests that pain treatment for older adults is often poorly assessed and administered, largely due to stereotyping of older adults as ‘cranky’ or ‘grumpy’ (Gamble et al., 2009). Moreover, recent evidence suggests that during the hospital stay, pain severity is often left unrecorded and unattended to (Zorg et al., 2014), leaving older patients in pain, hindering their recovery process. A specific nursing intervention which can be easily implemented is pain scale measuring. Blake and Fisher, (2017) argue that regular checks where patients reflect their pain level on a scale of 1 (very low pain) to 10 (extreme pain) can be carried out hourly, when needed, without incurring any extra cost to the hospital or specialised training of staff, and thus should be made a mandatory part of any care plan. In Mr Blackburn’s case his unattended pain resulted from the nursing staff labeling him as ‘a complainer’ or ‘a pain in the butt’. This stereotyping by nursing staff led not only to the patient’s discomfort, but increased his depression and sense hopelessness, which in turn extended his hospital stay. These negative consequences of Mr Blackburn's care resulted in poorer health outcomes incurring economic, social and emotional costs, which could have been avoided, had the pain measuring been seen as ‘standard practice’ and accurate records of Mr Blackburn’s pain levels been kept.

Nursing intervention and evidence

Take a break between when you finish writing and commencing editing.

Sample paragraph: Structure

Although pain is known to be common in all post-operative patients (Arnold & Goi, 2014; Riff & Trussier, 2016) there is minimal information about the patient’s pain experience among hospitalised older patients. Available evidence suggests that pain treatment for older adults is often poorly assessed and administered, largely due to stereotyping of older adults as ‘cranky’ or ‘grumpy’ (Gamble et al., 2009). Moreover, recent evidence suggests that during the hospital stay, pain severity is often left unrecorded and unattended to (Zorg et al., 2014), leaving older patients in pain, hindering their recovery process. A specific nursing intervention which can be easily implemented is pain scale measuring. Blake and Fisher, (2017) argue that regular checks where patients reflect their pain level on a scale of 1 (very low pain) to 10 (extreme pain) can be carried out hourly, when needed, without incurring any extra cost to the hospital or specialised training of staff, and thus should be made a mandatory part of any care plan. In Mr Blackburn’s case his unattended pain resulted from the nursing staff labeling him as ‘a complainer’ or ‘a pain in the butt’. This stereotyping by nursing staff led not only to the patient’s discomfort, but increased his depression and sense hopelessness, which in turn extended his hospital stay. These negative consequences of Mr Blackburn's care resulted in poorer health outcomes incurring economic, social and emotional costs, which could have been avoided, had the pain measuring been seen as ‘standard practice’ and accurate records of Mr Blackburn’s pain levels been kept.

Example

links to case and cause

Take a break between when you finish writing and commencing editing.

Sample paragraph: Structure

Although pain is known to be common in all post-operative patients (Arnold & Goi, 2014; Riff & Trussier, 2016) there is minimal information about the patient’s pain experience among hospitalised older patients. Available evidence suggests that pain treatment for older adults is often poorly assessed and administered, largely due to stereotyping of older adults as ‘cranky’ or ‘grumpy’ (Gamble et al., 2009). Moreover, recent evidence suggests that during the hospital stay, pain severity is often left unrecorded and unattended to (Zorg et al., 2014), leaving older patients in pain, hindering their recovery process. A specific nursing intervention which can be easily implemented is pain scale measuring. Blake and Fisher, (2017) argue that regular checks where patients reflect their pain level on a scale of 1 (very low pain) to 10 (extreme pain) can be carried out hourly, when needed, without incurring any extra cost to the hospital or specialised training of staff, and thus should be made a mandatory part of any care plan. In Mr Blackburn’s case his unattended pain resulted from the nursing staff labeling him as ‘a complainer’ or ‘a pain in the butt’. This stereotyping by nursing staff led not only to the patient’s discomfort, but increased his depression and sense hopelessness, which in turn extended his hospital stay. These negative consequences of Mr Blackburn's care resulted in poorer health outcomes incurring economic, social and emotional costs, which could have been avoided, had the pain measuring been seen as ‘standard practice’ and accurate records of Mr Blackburn’s pain levels been kept.

Concluding point and ‘So what’

Take a break between when you finish writing and commencing editing.

Sample paragraph: Evidence woven throughout

Although pain is known to be common in all post-operative patients (Arnold & Goi, 2014; Riff & Trussier, 2016) there is minimal information about the patient’s pain experience among hospitalised older patients. Available evidence suggests that pain treatment for older adults is often poorly assessed and administered, largely due to stereotyping of older adults as ‘cranky’ or ‘grumpy’ (Gamble et al., 2009). Moreover, recent evidence suggests that during the hospital stay, pain severity is often left unrecorded and unattended to (Zorg et al., 2014), leaving older patients in pain, hindering their recovery process. A specific nursing intervention which can be easily implemented is pain scale measuring. Blake and Fisher, (2017) argue that regular checks where patients reflect their pain level on a scale of 1 (very low pain) to 10 (extreme pain) can be carried out hourly, when needed, without incurring any extra cost to the hospital or specialised training of staff, and thus should be made a mandatory part of any care plan. In Mr Blackburn’s case his unattended pain resulted from the nursing staff labeling him as ‘a complainer’ or ‘a pain in the butt’. This stereotyping by nursing staff led not only to the patient’s discomfort, but increased his depression and sense hopelessness, which in turn extended his hospital stay. These negative consequences of Mr Blackburn's care resulted in poorer health outcomes incurring economic, social and emotional costs, which could have been avoided, had the pain measuring been seen as ‘standard practice’ and accurate records of Mr Blackburn’s pain levels been kept.

Take a break between when you finish writing and commencing editing.