Nursing in an ageing society

20th February 2013, by Margit Physant, Policy Adviser – Health and Wellbeing, Age UK. First published in “Too posh to wash? Reflections on the future of nursing”

The ageing population has implications for healthcare, and for nursing in particular. There are now more older people in society than ever before, they are more likely to be ill and admitted to hospital than others and they stay for longer. This means that caring for older people is a major part of the work of the NHS on most wards. Rather than just needing treatment for a single condition, older people are more likely to have complex needs as a result of underlying long-term conditions combined with the effects of ageing.

Dignity in care is essential. The quality of essential care has a profound effect on the lives of older people. Finding the right way to talk with an older patient and respond to their needs, wants and fears and treat them with respect, will help sustain and enhance that person’s self-confidence, independence and determination to remain active. On the other hand, poor care, even for a short time, can have a devastating impact. Older people describe how their skills and self-confidence deteriorate as a result of poor care, such as having things done to them rather than with them and being belittled by patronising language.

Poor treatment of older people does not happen in a vacuum; it is rooted in ageist attitudes in society. Older people are often described as a problem for care services and referred to as ‘bed blockers’. In contrast, the contribution made by older people, for instance in volunteering or caring for relatives, is rarely acknowledged.

Dignity is a right. Awareness of ageism and its effects has increased in recent years and the introduction of age discrimination legislation in the Equality Act 2010 is recognition of this. The Act provides protection against discrimination, harassment or victimisation on grounds of age. It also introduces a duty on public bodies to eliminate discrimination, advance equality of opportunity and foster good relations between different groups. Public bodies will have to consider how their services affect older people and this will need to be reflected in nursing. The NHS Constitution identifies several rights including the right to be treated with dignity and respect, in accordance with your human rights. The National Institute for Health and Clinical Excellence (NICE) recently published clinical guidance and quality standards for patient experience in NHS services which include these standards:

• Patients are treated with dignity, kindness, compassion, courtesy, respect, understanding and honesty.
• Patients have their physical and psychological needs regularly assessed and addressed, including
nutrition, hydration, pain relief, personal hygiene and anxiety.

The Care Quality Commission says that providers of health and social care who comply with its regulations will recognise the diversity, values and human rights of service users and uphold their privacy, dignity and independence. A number of reports exposing severe shortcomings in the
care of older people prompted Age UK, the NHS Confederation and the Local Government Association to establish the ‘Commission on Dignity in Care for Older People’ in July 2011. The aim of the Commission was to identify the underlying causes of poor care in hospitals
and care homes and determine what must change. The Commission gathered evidence and published the findings with a set of recommendations in February 2012.

This report, ‘Delivering Dignity’, recommended fundamental changes to health and social care:

Dignity in care: should be central to the teaching and training for all health and social care staff. Selection processes must ensure that prospective students understand and embrace the idea that they will spend much of their time looking after older people. Education and training programmes must reinforce the provision of dignified care and should include an understanding of ageing, dementia and dying.

Getting the right staff: Looking after older people is not simply a matter of common sense and sympathy. On the contrary, an older patient is far more likely to be suffering from a range of conditions which require skilled nursing. However, technical competence is not enough. Hospitals should recruit staff to work with older people who have the compassionate values as well as the technical skills.

Good care is everyone’s responsibility: Person-centred care champions compassion and respect and puts the individual at the heart of decisions. There is an imbalance of power in the relationship between a person receiving care and the staff providing it. Those who provide dignified care seek to redress this imbalance by involving the individual in decisions wherever possible, explaining what is happening, listening to and addressing concerns and, above all, treating each person with respect, empathy and kindness. While existing ‘dignity champions’ perform an important role, everybody involved in the care of older people must feel personally responsible for championing dignified care. Professionally registered staff are required to challenge poor care and they should do so as soon as they see any shortcomings. This helps colleagues understand how their care can be improved.
Health care providers should see older people’s families and friends as partners in care rather than as a nuisance. Working with families is not always easy as the stress of illness can tax even the most loving relationships. All this requires skilled, sensitive and empathetic support.

To achieve a major cultural shift in care, there is a need for empowered leadership on the ward as well as in the board room. The values of dignity must be consistently communicated throughout – by the board, managers, clinicians, team leaders and all staff.

Leadership and management: The leadership role of the ward sister or charge nurse is crucial. They should know they have authority over care standards, dignity and wellbeing on their ward, expect to be held accountable for it and take the action they deem necessary in the interest of patients. They should lead by example, helping other members of the team to deliver dignified care and challenging poor practice. In embedding values and behaviours around dignity, sisters and charge nurses should build on what is already being done correctly. They must ensure that every member of staff coming onto their ward understands the standards of care expected of them.

The commissions next step is to plan how these changes are made, for more information please visit http://www.nhsconfed.org/dignity

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