Challenges in Residential and Domiciliary Care
Question:
Discuss about the HLTEN608B Practice In The Domiciliary Health Care Environment.
Residential aged care facility is the certified facility where nurse care for old people can no longer live at home. It involves 24 hours nursing care together with other nurses approved by Aged care Act 197, to provide assistance with daily living activities, lodging and meal services. On the other hand the domiciliary care is the home care/social care provided by nurses who are not licensed, at patient’s home. Unlike the residential aged care facility, domiciliary care refers to non-medical care or custodial care. In both cases there are other health care professional involved but in the former the professionals are licensed (Rist et al. 2012).
|
Hazardous task |
Risks |
Solution |
|
Manual handling of patient |
Risk of fall |
Use of walkers, wheelchairs, and other assistive devices wherever necessary |
|
Repetitive movements when handling patient like cleaning bathroom, moping |
Musculoskeletal disorder due to overexertion |
Taking short breaks, wearing shock absorbing shoes and engaging physical exercise/strengthen muscles Implement OSHA guidelines |
|
Handling older patients with mental illness without any other supervision or working in isolation |
Risk of violence by patient and family members |
Use of CCTV cameras as an evidence to file a lawsuit against workplace injury |
(Worksafe.vic.gov.au 2018)
The role of the enrolled nurse is to function independently in the home care setting but seek guidance when needed to ensure quality and safety. The nurse must practice within the safety and quality guidelines of NMBA. The nurse must care for the client by recognising and responding to the health problems as observed through clinical manifestations. The enrolled nurse must engage in effective communication with the client and the family stay self motivated and have strong organisational time management skills. The enrolled nurse must be able to provide the client centered care and advocate considering gender/age/respect/dignity. The role of the nurse is to adhere to infection control principles, to maintain care safety and quality. The nurse must be ethical and non-judgemental in nature. When delivering duties of care, the nurse must maintain personal and the client’s safety (Levett-Jones and Bourgeois 2015).
The enrolled nurse must assess the wound and recognise the signs of skin disruption and infection. The nurse must design interventions for preventing infections and pressure ulcers. It may include helping client in maintaing good hygiene, nutrition, and educating about avoiding wound complications. The nurse administers medication as directed by physician and collaborates with registered nurse in case of complications. The EN must document the wound care and condition in detail
The role of the EN in personal care is to assist client in activities of daily living like bathing, dressing, feeding, and other tasks while making the patient feel comfortable physically and emotionally. The care also involves personal hygiene, assisting in cooking special food recommended by the physician, washing dishes, changing linens, and others activities of home making.
The EN must make the formal statement of the any workplace incident and seek union and legal advice. The EN must work in accordance with the “NSW Work Health and Safety Act 2011”, “code of practice and guidines. The EN must ensure that the client’s home is safe (chemicals, equipments, furniture’s, and fire alarm system). The nurse may educate client about the safety instructions and implement strategies to eliminate/reduce the risk (Yao et al. 2017).
Safety Guidelines and Solutions for Nurses
According to standard 5 of the NMBA EN standards, EN must coordinate with the registered nurse, with the members of the interdisciplinary team, to prioritise the work load, and development of the care plan. In addition, the nurse must collaborate and coordinate in decision making by participating in the multidisciplinary healthcare team meetings as well involving client in decision-making.
The nurse must play a vital role in caring, and treating the patients in rehabilitative care. The nurse must provide care for disability that is informed by research evidence. The nurse must assist the patient in learning activities of daily living. The nurse must determine the client’s progress by monitoring them during rehabilitation and therapy. The nurse must educate and assist the patients in living independently and deal with disabilities (Jacob, Sellick and McKenna 2012).
Registered nurse would be most suitable to conduct assessment. It is because RN obtains the license after meeting the requirements outlined by the state/country. They are specialised in the field of practice and able to supervise care delivered by other nurses (unlicensed/less experienced) (Jacob, Sellick and McKenna 2012).
- Orthopaedic specialist
- General physician
- Pulmonologist
Impaired physical mobility and strength
Risk of fall
Self care deficit
Acute pain in leg (Gulanick and Myers 2013)
The referral system is important in domically care if the patient needs care that is beyond the scope of practice of EN. Patients like Mary needs specialist care and there is need to refer to specialists appropriate for specific complication experienced by the patient. Referral system increases the access to right care, reduce loss of revenue, reduce long waiting times, and improve communication between the patient and the heath system (Arena et al. 2012).
It is possible to provide holistic care in domiciliary environment. The nurse may fulfil the client’s wishes with consideration and respect, giving range of choices. The nurse must be passionate about care and work with sensitivity, ensuring continuity of care. The specialised carer should be compassionate like family member and address social isolation by facilitating the befriending service (Poulymenopoulou et al. 2013).
I will identify the exact cause of refusing the medication (side effects or prejudice tat medicine does not work) and try to gain the patient’s perspective. I will discuss the importance of medicine to the patient compassionately giving concrete reasons. I will discuss with physician about change of medication.
Enrolled nurse will collect, record and document data or establishing the plan of care. The nurse must observe and collect information about client’s ability to perform activities of daily living. The nurse must identify the changes in the health status of the patient and report. The nurse will then contribute to the education of the patient regarding the health issues and care.
Roles of Enrolled Nurses in Domiciliary Care
Comprehensive assessment in the domiciliary health care environment is done by taking patient health history, physical assessment, mental status examination, psychological and functional assessment, lastly OHS assessment of the environment and equipment.
My role is to monitor the client’s response to the interventions and assess the effectiveness of the interventions in patient outcomes.
I will assess the patients and family for impact of the socio-economic and cultural factors associated with care provision. I will involve the family members to discuss about the client’s health status. With the consent of the client I will discuss the psychological, physical and social impact on daily living activities.
The impact of the health problem on the client in domiciliary health care can be known by detailed assessment of the client and observing the clinical manifestation of the health problems.
Enrolled nurse will design intervention consulting with RN and based on evidence. The interventions will be delivered complying with the professional standards of care. Safety and security issues will be considered while following the legal and organizational policies.
Nursing actions would be guided by the principle of treating with dignity and respect, taking responsibility for actions, ensure safety of care, and provide patient centred/holistic care (Huber 2017).
Evaluation is important to determine the status of the client and degree to which the expected outcome are achieved. Evaluation help identify the need to modify the care plan as per the potential complications uncovered.
The benefit of evaluation is to monitor the availability and accessibility of service. Evaluation will help identify the role of relevance of the interventions and the degree of integrating and coordinating care.
References
Arena, R., Williams, M., Forman, D.E., Cahalin, L.P., Coke, L., Myers, J., Hamm, L., Kris-Etherton, P., Humphrey, R., Bittner, V. and Lavie, C.J., 2012. Increasing referral and participation rates to outpatient cardiac rehabilitation: the valuable role of healthcare professionals in the inpatient and home health settings: a science advisory from the American Heart Association. Circulation, 125(10), pp.1321-1329.
Gulanick, M. and Myers, J.L., 2013. Nursing Care Plans-E-Book: Nursing Diagnosis and Intervention. Elsevier Health Sciences.
Huber, D., 2017. Leadership and Nursing Care Management-E-Book. Elsevier Health Sciences.
Jacob, E., Sellick, K. and McKenna, L., 2012. Australian registered and enrolled nurses: Is there a difference?. International Journal of Nursing Practice, 18(3), pp.303-307.
Levett-Jones, T. and Bourgeois, S., 2015. The Clinical Placement-E-Book: An Essential Guide for Nursing Students. Elsevier Health Sciences.
Poulymenopoulou, M., Malamateniou, F. and Vassilacopoulos, G., 2013. Specifying process requirements for holistic care. Informatics for Health and Social Care, 38(3), pp.302-312.
Rist, G., Miles, G. and Karimi, L., 2012. The presence of malnutrition in community?living older adults receiving home nursing services. Nutrition & Dietetics, 69(1), pp.46-50.
Worksafe.vic.gov.au (2018). Home care – occupational health and safety compliance kit: How to control the most common hazardous tasks in the home care sector. [online] Worksafe.vic.gov.au. Available at: https://www.worksafe.vic.gov.au/__data/assets/pdf_file/0005/207842/ISBN-Home-care-occupational-health-and-safety-compliance-kit-2011-06.pdf [Accessed 4 Mar. 2018].
Yao, N.A., Rose, K., LeBaron, V., Camacho, F. and Boling, P., 2017. Increasing role of nurse practitioners in house call programs. Journal of the American Geriatrics Society, 65(4), pp.847-852.
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