week 4 lecture Continuum of care
Part A:
Continuum of Care
for the Older Adult
NRSG266 Contexts of Ageing Week 4
Learning Outcomes
• On Completion of this week’s learning and
teaching activities students will:
• Understand the concept of “Continuum of Care”
and its impacts on quality of life for the older
person
• The role of a community nurse associated with
ageing
• The importance of Healthy Ageing
• Implementing the R-L-T model for a community
ageing health assessment
• Introducing the multi-disciplinary team (MDT)
available to assist the older person
• The importance of Healthy Ageing
Student Thoughts on Ageing
• During weeks 1 & 2 we considered
• Student thoughts on ageing and what caring for the ageing population entailed
• We introduced the concepts of ageism and stereotypes
• Quality of life
• How nurses can assist the older person
• Here are only some of your responses
Student thoughts and responses on ageing
Holland, K. & Jenkins, J. (Eds). (2019). Applying the Roper-Logan-Tierney Model in practice. Edinburgh: Elsevier, p.18
• Introduced during week 2 the R-L-T conceptual
framework considers a ‘model of living’
• It is essential for nurses to consider all aspects
of a client/patient’s life when undertaking a
comprehensive assessment
• 12 Activities of Living (ALs) were introduced as
seen in the diagram
• Comprehensive patient centred assessment
should take into consideration all ALs
• Assessment, Planning and Implementation are
all essential when supporting the continuum
of care for the older person
R-L-T Model in practice
Continuum of Care
Each person thus has a dependence/independence continuum
All aspects of living are influenced by the following circumstances, which ultimately influence health care
Biological Psychological Socio=cultural Environmental Politico-economical
The life span is a continuum
There are stages of the lifespan when a person is unable to yet or can no longer perform ALs independently
Continuous change occurs as we move through the lifespan
Five Stages of Life
Infancy Childhood Adolescence Adulthood Old age
The lifespan is a continuum that individuals move through from birth to death
Roper, Logan & Tierney, (2019)
Quality of Life
• Quality of Life is:
• “An individual's perception of their position in life in the context of the culture
and value systems in which they live and in relation to their goals, expectations,
standards and concerns”. (World Health Organisation, 2019)
https:
www.who.int/healthinfo/survey/whoqol-qualityoflife/en
• Quality of life is different for each of us, and is dependent on the components that the R-L-T model identify as
“factors that influence our ALs”
• Biological
• Psychological
• Sociocultural
• Environmental
• Politicoeconomical
• Aspects of what is important for our individual quality of life change as we move through the lifespan continuum
The importance of Healthy Ageing
• Healthy ageing is essential to maintaining a good quality of life
• We discussed in previous weeks that there are:
• Normal physiological changes of the human body as we age
• Individual choices that we make that may impact our ageing and QOL
• How does an RN assist a client/patient with their QOL?
• Communication?
• Assessment?
• Rapport?
• Simply getting to know someone and what is important to them?
Aged Care in Australia
• All RN’s must uphold our standards as outlined by AHPRA (2016)
• Standard 1: Thinks Critically and analyses nursing practice
• Standard 2: Engages in therapeutic and professional relationships
• Standard 4: Comprehensively conducts assessments
• Standard 5: Develops a plan for nursing practice
• Standard 6: Provides, safe, appropriate and responsive quality nursing practice
• Standard 7: Evaluates outcomes to inform nursing
https:
www.health.gov.au/health-topics/aged-care/about-
aged-care/what-is-aged-care
What is aged care?
1. Support for older people as
they age
2. Types of aged care services
3. Who is Eligible
4. Who provides aged care?
5. Our Aged Care System in
Australia
Role of a community aged care nurse
Case Scenario 2 : Karl and Francis
Our next Case Scenario on Karl and Francis is set in the community however be mindful that these
discussions are relevant to all aspects of aged care no matter the setting
• A community nurse should be able to improve and maintain the quality of life of older Australians
• Amongst others some important key skills for an aged care nurse to possess when working in the community include:
• Collaboration
• Assessment
• Working Independently and as part of a team
• Communication
• Advocacy
• Health promotion
• Education
Community Aged Care Services
• The community nurses
• Work in various settings and are focused on assisting clients with existing health conditions, to maintain and/or improve
their quality of life
• Refe
als are made to access a community nursing service
• Assessments are made
• Resources are accessed
• Ongoing assessment and supports continue
Aged Care services can include
Home care, District,
Day Care e.g. GP visits, outpatients, surgical
Respite (day only or for an agreed longer term)
Transitional Care
Long term care
Hospice, palliative care
Implementing the R-L-T model for a community
ageing health assessment
• Comprehensive patient assessment
• Now that we are aware of the RLT ALs, we can begin to think critically about how they are used for an aged care
assessment for a couple like Karl and Francis for example
• You may have heard of some of the resources available in the Australian Health care system both at a Federal and
at the various State and Te
itory levels
• A community RN can review a client/patient in their own home, GP Clinic or Hospital Setting for an initial
assessment
• As with any nursing assessment it must be patient centred, to ensure this use the 12 ALs as highlighted in the R-L-T
model
Implementing the R-L-T model for a community
ageing health assessment
• A community RN will undertake their own initial assessment once they receive a refe
al
• Once this has been undertaken the RN is able to ascertain if an ACAT assessment will help
• This initial assessment will be thorough when utilizing the R-L-T model
Questions about Assistance and Access
How do I get help?
What happens at an
assessment?
Is an assessment for a home
care package free?
I care for my husband on my
own…I am exhausted and
feeling stressed. Can I get
help?
The importance of enhancing the quality of life for clients/patients who are ageing within their
home and the community environment is undeniable
www.myagedcare.gov
Information and help for all Australians
https:
www.myagedcare.gov.au/assessment/prepare-your-assessment
An ACAT Assessment
What is an
ACAT
assessment?
1
What is an
ACAT team?
2
How much will
it cost?
3
I am
frightenend
4
myagedcare.gov
Time to watch how myagedcare.gov can help Australians
https:
www.youtube.com/watch?v=PQtsUgeLVWI
Refe
als
• In the past health care professionals worked in
individual professional silos for example;
1. Medicine
2. Nursing
3. Physiotherapy
4. Dietician
5. Occupational Therapist
• Sharing knowledge improves the lives of our
patients/clients and assists health care
professionals
• Multi disciplinary team (MDT) work and
accessing other professionals assists clients,
ourselves and outcomes
Introducing the multi-disciplinary team (MDT)
available to assist the older person
• Who works in aged care?
• Nurses
• Doctors
• Surgeons
• Podiatrists
• Wound Care Specialists
• Continence Specialists
• Physiotherapists
• Dieticians
• Occupational Therapists
• Social workers
• Patient Care Attendants
• Council Aid Workers
• Volunteers
• Can you think of any others?
Choices in Home Care
• https:
www.youtube.com/watch?v=Jqj5Gj2sWE4
• Reduce restrictions
• Provide support
• Build Rapport
• Provide Transport
• Mobility Options
• Meals on Wheels
• Domestic Assistance
• Living at home
• Aged Care Assessment
• Ask for helpTess from Canbe
a
https:
www.youtube.com/watch?v=a-3F1BYMgE0
Diana and Ignattius
https:
www.youtube.com/watch?v=dmHBolAJOPk
Applying the R-L-T model in Assessment
• Looking at Case Scenario 2 of a couple residing in their own home we can work through the 12 ALs as
outlined by R-L-T in their model of assessment
• This will provide community nursing team and other health professionals with valuable information to
assist Karl and Frances with their needs
• This thorough assessment began with the GP and the continuum of care for Karl and Frances will be
ongoing
• It is likely that other health professionals will assist and be involved in their care
Case Study 2
• Community RN visiting a couple (Karl and Frances) in their own home
• Subjective and Objective data need to be obtained to ascertain their needs both
cu
ent and potential
• Working through the Clinical Reasoning Cycle will assist with the establishment of
SMART goals providing them with support needed to stay at home for as long as
they can
Clinical
Reasoning Cycle
• How can we best
help Karl and
Frances?
Moving Forward
• Sharing knowledge improves the lives of our patients/clients and
assists health care professionals
• In the past health care professionals worked in individual professional
silos for example;
1. Medicine
2. Nursing
3. Physiotherapy
4. Dietician
5. Occupational Therapist
• The list is endless, together we can make a difference in the quality of lives
of our clients/patients, their loved ones, our colleagues and peers
NRSG 266 Principles of Nursing: Contexts of Ageing
NRSG 266 Principles of
Nursing: Contexts of Ageing
Week 3 Lecture:
• Psychosocial theories of ageing
• Non-physical changes associated with ageing
Learning outcomes week 3:
On completion of this week’s learning and teaching activities the
student will:
• Recognise that ageing may effect psychosocial health status
• Describe how age-related changes influence psychological health,
social interactions and socio-economic status and belief systems
• Describe the main psychosocial theories of ageing and explain their
effect
Psychosocial theories of ageing:
• Represent ideas about psychological and social changes resulting
from or influenced by the ageing process
• Attempt to explain the factors influencing how individuals manage
such behavioural, cognitive and emotional change
• Attempt to explain the inte
elationship between older adults and the
social environments in which they live
• May predict outcomes
Mrs Anna Maria Morteno is 70 years old.
She is …
• Second generation Greek-Australian
• Ma
ied to Alec, a retired factory worker, for 53 years.
• Anna Maria has a close relationship with her siblings and their families
• Her grown adult children and her siblings live within the same subu
and are close knit.
• Her parents passed away 3 years ago, within a few months of each other. (What ages would they have been?)
• Anna Maria retired from her role as a senior li
arian two years ago, and now enjoys caring for, and playing with, her
seven grandchildren whenever she can.
ROLE THEORY:
Based on the belief that roles define us, our identity and self-concept, and shape our behaviour.
As we age we take on new roles and complete others
• Context: Anna Maria was a Li
arian, how do you think this influences her interactions with her grandchildren?
Age norms – “culturally constructed expectations of what is deemed acceptable behaviour in society” (Touhy & Jett, p.
41).
Successful ageing means that each new role holds similar value through adjustment to the new role.
However …
• This theory does not consider influence on social factors such as class, education and income on the ageing process.
Mrs Anna Maria Morteno is 70 years old.
She is …
• Second generation Greek-Australian
• Loves to spend time in her garden
• Enjoys cooking for large family gatherings
• Has a strong faith and attends church each week.
• She attends a dance class every Wednesday with a group of friends.
• Walks three kilometres a day no matter what the weather.
ACTIVITY THEORY:
That the continuation of activities ca
ied out during middle age is necessary for successful ageing.
Successful ageing is dependent on the individual maintaining an active lifestyle. According to Hunter and Miller (2016 p.
58), older people may remain both psychologically and socially fit if they can continue with some kind of active
engagement in life.
• Context: Anna Maria loves to work in her garden and walks three kilometres every day no matter what the weather is
like, she walks with Alec.
• She likes to cook for her family, particularly large family gatherings.
Within this theory it is believed that activity, interest and involvement should not diminish with ageing. When you look
at some of the research in this area, new and continuing social interests and roles are important to the older person’s
sense of identity, life satisfaction and well being.
While Anna Maria and her lifestyle/lifespan choices seem to align with Role Theory and Activity Theory, conside
DISENGAGEMENT THEORY:
That ageing is a process where people turn away from active involvement with others and turn inward, people may
ecome more self-focused or preoccupied in a way that produces gradual withdrawal from social roles (Johnson & Chang,
2017).
Within this theory there is a move between society and the individual where the individual draws back of disengages from
other people – at times to their mutual satisfaction and benefit.
• The individual may be more focused on self once free of social expectations
• Society benefits from the orderly transfer of power across generations.
Does this fit with Anna Maria and her choices?
Have you encountered what seems like a disengagement from society within older people? Some residents in RACF’s may
align with disengagement theory.
This theory does not account for cultural diversity, sociocultural context or individual preference and choice.
• While it can be difficult not to stereotype Anna Maria – it is well known that the Greek community are excellent cooks
and have wonderful variety within their food and culture.
• Anna Maria loves to garden, cook and spend time with her grandchildren. She remains active by walking everyday. She
does not align with disengagement theory.
Consider what has been presented here, that these are theories. They are Psychosocial theories of ageing.
• They represent ideas about psychological and social changes influenced by ageing.
• They attempt to explain factors that influence how individuals manage behavioural, cognitive and emotional change
while ageing.
• They can predict social and emotional outcomes of actions, decisions and behaviours, however …
• They are not absolute. They are theories.
Here are a few more.
Continuity theory
“Aging, as an extension of earlier life, reflects a continuation of the patterns of roles,
esponsibilities and activities.” (Touhy & Jett, 2018, p.42)
Successful ageing is determined by how well the older adult maintains this continuity (Johnson &
Chang, 2017)
Internal continuity – personality traits, attitudes, beliefs, values
External continuity – social interactions, relationships, sociocultural context, environment
• Assumes older adults rely on their past (experiences, decisions, behaviours, coping strategies) to
inform their future; and that ageing is a smooth transition in which a
upt changes do not occur,
change is gradual, which allows the older person to adapt
• Problems -
• considered to be simplistic; not accounting for the complexity of factors influencing ageing
Johnson, A. & Chang E XXXXXXXXXXCaring for older people in Australia (2nd ed.). Milton, Qld: Wiley; Touhy, T. & Jett, K XXXXXXXXXXEbersole and
Hess’ Gerontological nursing and health aging (5th ed.). St Louis Missouri: Elsevier.
Theory of Gerotranscendence (Tornstam 1989, 1994)
• Builds on disengagement theory
• “A positive, lifelong continuous development towards gerotranscendence” (Johnson & Chang, 2017, p.37) - a
shift from materialistic rational view to cosmic transcendent view which is accompanied by an increase in life
satisfaction
• Increased feelings of peace and contentment
• Changed perception and experience of space and time
• Enhanced interest in spiritual, mystical aspects of living and ageing
• Decreased fear of death
• Greater focus on meaningful relationships (Johnson & Chang, 2017)
• Emphasises the transcendent aspects of old age, that is, the person experiences a redefinition of self and
fundamental shift in the way the world is experienced
• Places focus on inner self as positive characteristic of old age
• Problems: -
• too egocentric in focus
• Does not consider sociocultural economic and environmental factors that may prevent such introspection and contemplation
Johnson, A. & Chang E XXXXXXXXXXCaring for older people in Australia (2nd ed.). Milton, Qld: Wiley.
Approximate Age Psychosocial crisis Existential question
Infancy Trust vs. Mistrust Can I trust the world?
Toddlerhood Autonomy vs. Shame/Doubt Is it okay to be me?
Early childhood Initiative vs. Guilt Is it okay for me to do, move, and act?
Middle Childhood Industry vs. Inferiority Can I make it in the world of people and things?
Adolescence Identity vs. Role Confusion Who am I? Who can I be?
Early adulthood Intimacy vs. Isolation Can I love?
Middle Adulthood Generativity vs. Stagnation Can I make my life count?
Late Adulthood: 60 and above Ego Integrity vs. Despair Is it okay to have been me?
Theory of psychosocial development (Erikson, 1963)
Hunter, S. and Miller, C XXXXXXXXXXNursing for wellness in older adults, 2nd Australian and New Zealand Edition. North Ryde, NSW: Lippincott, Williams and Wilkins;
Johnson, A. & Chang E XXXXXXXXXXCaring for older people in Australia (2nd ed.). Milton, Qld: Wiley.
Theory of psychosocial development
Proximity of death in old age leads to -
• questions
• “What has my life meant?” “ Is it OK to have been me? ”What have I to grieve,
to be proud