This essay will also look into potential problems that highlight the necessity for co-ordinated multidisciplinary guidelines that set out the responsibilities of all professionals and the options for intervention. Having a clear focus on prevention and empowerment (Pettee, 1997), it will also explore refusal of medical and surgical interventions common among chronically ill elderly and should a nurse intervene. Interventions must strike an ethical balance between protection and the right to self-determination (Bennett et al, 1997; Pettee, 1997).
Ageing may be accompanied by deteriorating health, a declining quality of life and increased demands on the health services (CSAG, 1998). Presently older people are the largest group of health-care consumers. The NHS spends �10 000 million on older people. Social services spend �5216 million annually. As people age they increasingly require input from a variety of external sources, in particular health and social care services (victor 1994). The prediction is that by 2030 in the UK the number of people over 85 will have doubled. (Official Population Census Survey (OPCS) 2001).
The National Service Framework (NSF) for older people was first developed on 27 March 2001 to provide a higher standard of care. The service looks at the problems faced by the older population when receiving care from the National Health (NHS) and other health care services. The framework is looking at promoting independence support and a high quality service for older people… It sets new national standards and service models of care across health and social services for all older people, whether they live at home, or in residential care or are being looked after in hospital. The NSF leads with plans to:
Tackle age discrimination and to make it a thing of the past, and to ensure older people are treated with respect and dignity. It also plans to ensure older people are supported by newly integrated services with a well co-ordinated, coherent and cohesive approach to assessing individual’s needs and circumstances and for commission and providing services for them. It also aims to specifically address the conditions which are particularly significant for older people – stroke, falls and also mental health problems associated with older age
Promoting the health and well-being of older people through co-ordinated actions of the NHS and councils. Some of the targets are as follows, to improve care standards, extend services, and to help people over the age of sixty five stay healthy (DOH 2001). Prior to the national service framework was put into operation, services were deteriorating, this may be due to the escalation of an aging population. People are now living longer and the health service was unable to cope with the demands.
The NSF for older people (DoH 2001) Standard 8 is dedicated to the promotion of health and active life in older age. Older people, in terms of adult nursing, reach into every aspect of healthcare with the exception of obstetrics and paediatrics. In addition, two-thirds of hospital beds are occupied by people aged over 65. The Dignity in Care Campaign, launched on 14 November 2006, by the Minister for Care Services, Ivan Lewis MP, aims to eliminate tolerance of indignity in health and social care services through raising awareness and inspiring people to take action. To date this campaign has focused on older people and from August 2007, the campaign is being extended to include people with mental health needs.
It is a stated ambition of the government and department of health to root out age discrimination in the NHS. NHS services should be provided on the basis of clinical need alone. In 2006, the DoH published A New Ambition for Old Age, which sets out the priorities for the next phase of reform under three themes; Dignity in Care, Joined Up Care and Healthy Ageing. It consists of ten programmes driven nationally and covers the second half of the 10 year NSF for Older People.
People are living longer (Smith, 1995), and increasingly require nursing care, medication and supervision as their health deteriorates. Nurses working with older people need to empathise that the older patient has had a lifetime of dealing with stressors and in doing so have developed a range of coping mechanisms which include cognitive, behavioural and emotional responses and methods.
Fennel et al. (1988) suggests that an essential part of old age is retirement, particularly as it is used as an indication that old age has started. Older people find themselves officially bound to retire at a given age i.e.65, whether they consider it appropriate or not. The role of the nurse advocate is to prevent harm and promote good. Seedhouse (2000) believes the normal meaning of advocacy is to address on the behalf of some other person as that person sees his or her interests. Spiritual needs and psychosocial needs are much less actual than physical needs because they are often abstract, complicated and more difficult to measure.
In terms of ethical theory, this means having a respect for the autonomy of the person to make decisions about their own treatment and be provided with information available in order to do this. (Rowson (1990) defines the term ethics as thinking and reasoning about morality. Beauchamp and Childress (1994) assert that ethics is designed to illuminate what we ought to do by asking us to consider and reconsider our ordinary actions, judgements and justifications. They also developed an ethical framework based on 4 moral principles. These are beneficence, non-maleficence, justice and autonomy. Ethics is about the values that underlie moral choices of, for example, right or wrong, good or bad actions for which responsibility must be taken by the mature adult (Thompson, 2000).
Autonomy means recognising patients as a person who is entitled to such basic rights as the right to know, the right to privacy and the right to receive care and treatment (Thompson et al, 1994, p.60). So the principle of informed consent, where a person understands completely the implications of having or refusing a treatment, is one which is held in the nurse’s mind when suggesting treatment options. (Rumbold 1999). (O Brien (1987) states that choice is the experience of growing autonomy from both small everyday matters to the larger more life defining events.
People can on occasion set out their opinions and wishes for their treatment in advance, in case they lose the capacity to decide (for example, if they fall into a coma or develop dementia or alzheimers). These are usually called living wills. Living wills can include general statements about your wishes, which are not legally binding, and specific refusals of treatment called ‘advanced decisions’ or ‘advance directives’. A key principle of the law is that every adult has the right to make their own decisions and is assumed to have capacity to do so unless it is established otherwise.
Some people may require help or support to be able to understand the choice they are being asked to make, to know how to make a decision or to be able to communicate, but the need for help and support, this does not take away their right to make their own decisions. This principle applies in the same way to health care and treatment decisions. Older people must also be able to maintain the right to refuse interventions and it is vital that professionals respect this right, despite their wish to resolve abusive situations (Bennett et al, 1997). Norton et al. (1962) identified that the fundamental aim of nursing older people is to develop and maintain independent living. Patients have an entitlement to determine what happens to their own bodies and valid consent must be obtained if the patient is capable to give it before first starting treatment. Some patients may need help and support to be able to provide, or refuse, consent.
Patient consent is the principle that anyone over the age of 18 has the right to accept or decline all physical interventions from operations and injections, to help with getting dressed. If a patient should opt not to give consent then the nurse faces an ethical dilemma as it is her duty in accordance with the NMC code of professional conduct, standards for conduct and performance and ethics, which states that the nurse is to act to identify and minimise the risk to patients and clients. So if a nurse gives her patient the respect of autonomy and he chooses not to go ahead with life saving treatment this could appear not to be adhering to the NMC (NMC, 2002).
Patients should benefit from care that is centered on the individual and patients should be able to make choices about their care. The patient’s opinions and needs should at all times be respected. Nursing staff should endeavour for the utmost level of independence possible for individual patients. Also, a nurse should share any information with their patients that may impact their health and empower them to use this information to benefit their health.
Teach patients not only about their illnesses, but about wellness. Educate patients about what is healthy for their age, the screening that should be done as they grow older, health promotion behaviors, and specific disease management and complication prevention measures. Educate patients to invoke change not just because it is documented on a care plan. Teach from your own experience using methods you know worked for you, your family members, and other patients (Nettina .M.). angie Page 5 02/09/2008 People’s dignity must also be maintained all through their stay in hospital. This includes when they are being helped to eat, dress or bathe.