Nurse discrimination against elderly patient Essay Example

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11NURSE DISCRIMINATION AGAINST ELDERLY PATIENTS

Nurse Discrimination against Elderly Patients

College:

Nurse Discrimination against Elderly Patients

Nurse discrimination against elderly patients is now a common issue in health care, especially because of the increasing number of these patients due to increasing life expectancy in countries such as Australia (Pope, 2012). This essay will explore ageism towards patients in health care based on current literature findings to further discuss the main factors that cause nurse negative attitudes and ageism. This paper will be based on the Gibbs model to critically reflect on a nurse’s discrimination against an elderly patient from the view of a nurse who observed the situation in a past placement experience. This model entails six steps namely; description, feelings, evaluation, analysis, conclusion and action plan (Gibbs, 1988). Recommendations and strategies will be provided to address the issue of ageism in nursing in order to improve the quality of care for future nursing practice.

In nursing practice, there is rampant discrimination against elderly patients by nurses which is based on nurse’s judgmental attitudes towards these patients. Nurses all over the world have the tendency to discriminate against elderly patients based on their physical and mental state, because unlike other patients, the elderly are less independent and have less decision-making capabilities (Pope, 2012). This leads to challenges of hygiene, understanding and processing of information, making it difficult for nurses to work with them. According to Lamet et al., (2011), young nurses are especially have a high degree of negativity towards elderly patients. Ageism is thus, a significant issue that needs to be addressed in health care. Ageism is defined as discrimination against elderly people which is either intentional or subconscious (Simkins 2007). This, in health care, leads nurses to treat the elderly with disrespect such as not listening to them, and disregarding their autonomy and privacy among other issues. In a case as the one featured in this essay, the nurse witnessed a colleague using rude words in address to the elderly patient while also neglecting the patient by not paying heed to his complaints. Unfortunately, nurse negative attitudes increase morbidity of elderly patients often due to delayed care, disregard for their care needs and inadequate medical attention (de Boer, 2010).

Ageism results from several factors such as lack of knowledge by nurses, preferred area of practice, and observing other nurses doing the same, as well as cultural attitudes toward the elderly. Knowledge is a key factor in exploring ageism because the lack of knowledge on the ageing process as well as the care needs of elderly patients leads to discrimination and negative attitudes toward them (Mellor, Chew and Greenhill, 2007). In this regard, nurses do not have the ability to modify care in order to meet specific needs of the elderly such as the lack of ability to make decisions and lack of independence. Nurses’ preferred area of practice is also a major contributing factor to negative attitudes towards elderly patients. Many nurses, especially student nurses and those who are fresh graduates prefer to work in areas where patients do not pose significant challenges or become burdensome in their care needs (Pope, 2012). This preference leads nurses to regard elderly patients negatively because they need more intensive care in view of their lack of independence and often, decision making ability. The nurses’ negative attitudes lead to neglect and biased care when placed in charge of the elderly patients. Exploring nurse discrimination against elderly patients is important because it impacts on the quality of care provided for the patients (Marshall, 2010). According to the Australian Nursing and Midwifery Council (2005) standards, nurses are required to treat all patients equally regardless of their age, culture, race, religion, gender, physical and mental state. This means that it is wrong for nurses to discriminate against elderly patients even when their physical or mental state is undesirable. Nurses ought to treat elderly patients with respect, by safeguarding their dignity and autonomy regardless of their physical state. Even when their mental state is not up to par, their dignity and autonomy must not be disregarded (Welford, Murphy, Rodgers and Frauenlob, 2012).

There is sufficient literature to show that ageism impacts the quality of care negatively. As already established, one of the major causes of ageism is lack of knowledge (Topaz, M., Doron, I., 2013; Higgins, I., van der Riet, P., Slater, L. and Peek, C., n.d. 2007). Thus, it is vital for the health care field to address the issue of ageism because it leads to increased morbidity of the elderly patients among other great impacts such as health complications that are difficult to manage. There is also a different view point that suggests that ageism is an inherent part of human nature. However, this literature does not suggest any means with which to reduce its occurrence (Simkins, 2007). This point does not seem to represent accurate information on the causes of ageism because attitudes are formed through the influences of the environment, culture, education and personal beliefs. The suggestion by this literature that there is no solution for ageism in health care will lead to further discrimination of elderly patients, because nurses may use this literature to justify their negative attitudes.

Nurses’ discrimination against elderly patients is a grave issue in health care because one of the major implications as suggested by research is that it leads to neglect of patients and delayed or withheld care. This often leads to health complications and even death of elderly patients (Wai-Tong & Lee, 2007). In addition, research suggests that discrimination against elderly patients leads to the abuse of the patients by nurses (Afolayan, Fatai and Afolayan, 2011). Even in cases where the patients are in a position to make decisions, nurses often withhold information, inflict pain, confine care and medication, and disregard the patients’ dignity, autonomy and privacy. Such treatment stems from negative attitudes by nurses that lead to generalization of all elderly patients as being a bother and unworthy of respect. The gravity of this issue means that the importance of addressing discrimination of elderly patients cannot be overstated. Research suggests that ageism stems from stereotypes about the elderly which exist in society. When these stereotypes are carried into health care, nurses develop negative attitudes towards the elderly patients, often due to lack of knowledge on the ageing process and the care needs of elderly patients (Brenner et al., 2006). This observation is supported by research findings which suggest that nurses with more knowledge on geriatrics show more positive attitudes towards elderly patients, and thus less discriminatory attitudes, which translate to better quality care.

Nurses should also adhere to the nursing guide and standards of care to all patients. This can be a strong position from which to change negative attitudes toward elderly patients. Standard 2.6 of the ANMC National Competency Standards for the Registered Nurse (2005), suggests that a nurse should integrate nursing and health care knowledge, skills and attitudes in providing safe and effective care. Thus, a nurse should also take initiative in correcting personal negative attitudes toward elderly patients. One way in which nurses can do this is through critical reflections, which is an approach of self-evaluation to see how certain attitudes, beliefs and other personal factors affect a nurse’s competence of practice (Browden, 2008). Additionally, ANMC (2005) stipulates in Standard 2.3 that a nurse should provide non-judgmental care to all patients. Some of the ways to provide such care is by being sensitive towards patients’ needs, respect of patient’s preferences, dignity, autonomy, and rights. When nurses adhere to these standards in caring for elderly patients, it will ensure that negative attitudes and discrimination against the patients are reduced. Thus, it is possible to reduce ageist attitudes and eventually nurture a nursing culture that does not discriminate against elderly patients. This has to be done by nurses at an individual level, with the help of their health care institutions and society in general through changing cultures that discriminate against the elderly. According to Carter and Xu (2007), research suggests that cultures that give emphasis to provision of quality care for elderly patients produce larger volumes of nurses with more positive attitudes toward these patients.

In the Gibbs model, description entails saying what happenned without making judgements or drawing conclusions. Feelings are about what the nurse’s reactions and feelings were in the situation. Evaluation entails looking at what was good or bad about the situation by making value judgements. Analysis is about the sense that one can make out of the situation,conclusion entails making general as well as specific summary of the analyses of the situon. Lastly, action plan entails the steps to be taken inorder to avoid a similar situation imn future (Gibbs 1988). In the case applied in this paper, a student nurse witnessed a case in which during the handover at the bedside of an older patient, the clinical nurse handing over expressed hateful looks toward the patient, and said out loud that “I hate to look after old patients”. She also looked at the patient and referred to him as a “bed blocker”. The nurse did not give the patient any attention, even though his condition was getting worse.

The student nurse felt uncomfortable at the nurse’s action and speech toward the elderly patient. The clinical nurse seemed to act carelessly and irresponsibly, which can be translated as unprofessional. In effect, the nurse’s negative attitude toward the patient impacted on the quality of care because already, she was neglecting the patient’s care needs while showing disregard for his rights, dignity and respect. The speech and actions depicted by the clinical nurse may influence the attitudes of other health professionals toward elderly patients. Besides, the patient can easily lose his trust in the nurse, leading to his lack of cooperation in his care, which can result in complications. The most appropriate action in this case was for the student nurse to report the clinical nurse’s attitude to the proper authority, because it poses significant risk on the care of elderly patients.  From this clinical experience, the student nurse learnt the impact of using the judgmental attitudes toward elderly patients. If the same situation happened again, the student nurse would point out the negative attitude of the nurse and remind her to provide appropriate care for the patient, for timely intervention on the patient’s condition.

There are various recommendations on how to deal with ageism in health care. Besides, several strategies will also be suggested on how to cultivate positive attitudes in nurses. The first recommendation is that nurses should be continually educated and trained on geriatrics and the care needs of elderly patients. Education helps to improve nurses’ attitudes to foster positivity in the care of elderly patients (Brenner et al., 2006). The best strategy to educate nurses is for the health care institutions and the sector at large to hold regular geriatrics education conferences and training sessions for all nurses. Additionally, this can also be achieved through advocacy in which only well trained nurses with sufficient knowledge in geriatrics take care of the elderly patients. Besides,as Alsenany (2009) suggests, nurses’ discrimination against elderly patients can be reduced through entrenching education on the elderly in cultural perspectives. This can be achieved through the strategy of engaging in community education forums that help society to become aware of existing negative attitudes towards the elderly, and consequently correct them.

Another recommendation is for health care professionals to reduce negative labeling of elderly patients using verbal expressions during their health work. This would help in improving attitudes at the work place and encourage a culture of positivity in the care of the patients. This would also aid to avert all negative impacts on elderly nursing care such as missed symptoms, and development of complications because when a nurse’s performance is filtered by his or her negative attitudes, they cannot provide quality care to the patients (Backrach- Lindstrom 2007). The best strategy to use is to set up specific policy on the care of elderly patients both through nursing as an institution and the government as well.

Discrimination of elderly patients is rampant in health care around the world. This essay has looked at ageism and how it impacts the quality of care accorded to these patients. Using current literature, it has been established that ageism has severe impact on elderly patients including increased morbidity at worst, while also leading to complications of their health due to delayed and withheld care. In this regard, education, change of cultural attitudes and advocacy have been established as key ways in which to deal with ageism in health care. Besides, it should be insisted that nurses follow nursing standards that among other stipulations require nurses to treat all patients with equality, dignity, and respect according to nursing and health care knowledge, skills and attitudes.

References

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, Retrieved from http://www.britishgerontology.org/DB/gr-editions-2/generations-review/student-nurses-attitudes-and-knowledge-towards-the.html British Society of GorontologyStudent nurses’ attitudes and knowledge towards the care of older people in Saudi Arabia. Alsenany, S. (2007)

Australian Nursing and Midwifehry Council (ANMC) (2005).National competency standards for the registered nurse. Retrieved from www.anmc.org.au.

Bachrach-Lindstrom, M.,Jensen, S., Lundin,R., and Christensson, L. (2006). Nutrition and Older People. Journal of Clinical Nursing, 2007-014. Retrieved from: http://web.ebscohost.com/chc/pdf?vid=6&hid=5&sid=c7b708a8-6852-49bf-a550-f37f79f83bc4%40sessionmgr3

Bowden, S.D. (2008) Enhancing your professional nursing practice through critical reflection, Abu Dhabi Nurse, Summer, pp. 28-31.

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Carter, K.,F., and Xu, Y. (2007). Addressing the hidden dimension in nursing education — promoting cultural competence. Nurse Educator, 32(4), pp. 149-153.

de Boer, M.J. (2010). Discrimination of the elderly: how guilty are you? Netherlands Heart Journal, 18(5): 227.

Gibbs, G. (1988) Learning by Doing: A Guide to Teaching and Learning Methods. Oxford, Further Education Unit.

Higgins, I., van der Riet, P., Slater, L. and Peek, C., n.d. (2007) The negative attitudes of nurses towards older patients in the acute hospital setting: A qualitative descriprive study, Contemporary Nurse, 26(2), pp: 225-237.

Lamet, A.R., Sonshine, R., Walsh, S.M., Molnar, D. & Rafalko, S. (2011). A pilot study of a creative bonding intervention to promote nursing students’ attitudes towards taking care of older people. Nursing Research and Practice, 2011, 1-7. doi:10.1155/2011/537634

Marshall, L.C. (2010). Potential implications of registered nurse attitudes towards caring for older people. Contemporary Nurse Journal, 35(1), 95-99.

Mellor, P., Chew, D., & Greenhill, J. (2007). Nurses’ attitudes toward elderly people and knowledge of gerontic care in a multi-purpose health service (MPHS). Australian Journal of Advanced Nursing, 24(3), 37-41.

Pope, T. (2012).How person-centred care can improve nurses’ attitudes to hospitalized older patients. Nurs Older People, 24(1), 32-6.

Simkins, C.l. (2007) Ageism’s influence on health care delivery and nursing practice. Journal of Nursing Student Research, 1(1), pp: 24-28.

Topaz, M., Doron, I. (2013). Nurses’ attitudes toward older patients in acute care in Israel. OJIN: The Online Journal of Issues in Nursing, 18 (2). doi: 10.3912/OJIN.Vol18No02PPT01.

, pp. 52-71.International Journal of Multiple Research Approaches Wai-Tong, C., & Lee, I. (2007). Psychiatric nurses’ knowledge and attitudes toward the use of physical restraint on older patients in psychiatric wards.

Welford, C., Murphy, K., Rodgers, V.,&Frauenlob, T. (2012).Autonomy for older people in residential care: a selective literature review. International Journal of Older People Nursing, 7(1), 65-69.