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HNN 318 Care Of The Older Person

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HNN 318 Care Of The Older Person Question: Purpose An important professional responsibility and unique role of the Registered Nurse (RN) within the health care team is to coordinate the 24?hour environment of care. In the residential aged care setting coordination of care can often involve delegation and supervision of non? registered nursing and care staff members such as Enrolled Nurses (ENs) and Patient Care Attendants (PCAs). The purpose of this assessment is to examine the nurse’s role in providing supportive care for the older person. Assignment Question: Discuss the RN’s role in enacting coordination, supervision and delegation of quality and safe functional care provided by non?registered nursing staff (ENs and PCAs) in order to optimise the functional outcomes of an older resident diagnosed with dementia. Answer: Introduction   Dementia is a degenerative disease, which is persistent and chronic. This disease is caused by the damages occurred in the brain. This disease significantly affects the functioning of the patients and give rise to memory problems, impaired reasoning and personality changes. It is not a specific disease but it includes the wide range of the symptoms that impacts the overall well-being and quality of life of the patients. According to the report Dementia is the most common kind of Alzheimer disease, which accounts for 50% to 75% cases of Alzheimer (Dementia in Australia, 2012). the incidents of dementia has increased over the years and the median age of people, who died with dementia is 88.6 years (Australian Bureau of Statistics, 2015). Dementia is also considered as the leading cause of mortality in older people of Australia, which leads to high economic burden on the patients, families and health care system of the country (Australian Bureau of Statistics, 2015). Role of registered nurse is very significant in providing dementia care to old people. Registered nurses provide the supportive and restorative care to dementia patients by using evidenced based skills and knowledge. Registered nurses are also skillful in coordinating, delegating and providing clinical supervision for enhancing the care delivered to dementia patients. Therefore, this paper will discuss the role of RN in enacting coordination, supervision and delegation of quality and safe functional care provided by non?registered nursing staff (ENs and patient care assistants (PCA) in order to optimizing the functional outcomes of an older resident diagnosed with dementia. Role Of Registered Nurse In Care Coordination, Delegation And Supervision Of Care Registered nurses play an integral role in providing coordinated and efficient care to the patients. They support their practice with the various quality standards to provide quality care to the consumers. Care coordination, delegation and supervision are the most significant parts of registered nurse practice in the aged care setting. These steps are important because they are focused on developing effective care plans, considering the needs and preferences of the patients and facilitating continuity of care. The continuity of care is facilitated among the professionals and across the settings. Registered nurses are in right position to provide coordinated care with appropriate delegation and effective supervision.  Care coordination Care coordination is the way of providing the streamline care to the patients suffering with complex diseases. Care coordination is the way through which the team of professionals works in a collaborative manner and provides quality care to the older patients (Anderson, St Hilaire, & Flinter, 2012). Registered nurses play leading role in providing coordinated care to the patients suffering with dementia. Within the team of the healthcare professionals the interventions are required to be workable. His can only be achieved by integrating the workable interventions in routine practice. Care coordination is also the significant part of the routine practice of registered nurses. (Cropley & Sanders, 2013). Therefore, it is correct to say that registered nurses provide the frontline leadership in services coordination, delegation and supervision of the care provided by other professionals. According to the study of Ashley (2013) “the registered nurse demonstrates competence in the provision of nursing care as specified by registration requirements, National Board standards and codes, educational preparation, relevant legislation and context of care”. Registered nurses are responsible for providing quality care to the patients in different clinical settings by appropriate care coordination with multidisciplinary team. Coordination also helps in effective information sharing (Anderson & St Hilaire, 2012). According to the definition, “Delegation is the transfer of responsibility for the performance of an activity from one person to another with the former retaining accountability for the outcome” (Guideline: responsibilities for direction and delegation of care to enrolled nurses, 2011). Registered nurses are not only responsible and accountable for their practice, but they are also responsible for coordinated care, delegation of duties and supervising the enrolled nurses and Patient care assistants (PCA’s) (Birks et al, 2016).  The concept behind delegation is to enhance the quality of care provided to the older patients and also improving their health outcomes. Therefore, it is said that delegations are meant to meet the health care needs of the patients, which also ensures that correct person should always respond to needs of patients (Delegation and supervision guidelines for Victorian nurses and midwives, 2014). Delegation of the duty or the care requires to be focused on the 5 Rights of the delegation. The first right is the ‘Right activity’, which includes the skill of professional judgment made by RN (Guideline: responsibilities for direction and delegation of care to enrolled nurses, 2011). The first right of delegation states that RN delegates the duty according to the knowledge and scope of practice of the enrolled nurse. The second right is the ‘Right Circumstance’, which means that appropriate consumer group, appropriate resources are available and other relevant factors are considered. Next right is the ‘Right Person’, which means that right duty is being delegated to the right person, who has the right knowledge and right skills to assist the right professional. Fourth right is the ‘Right Communication’, which means that clear and concise information has been offered to the right person for undertaking the right activity with the objectives and expected outcomes. The last right is the ‘Right Direction’, which means right direction in the form of evaluation, intervention, monitoring and feedback is being provided by the registered nurse. These five rights are very important in providing quality care to the patients with complex condition in the multilayered health care system (Ehrlich, Kendall& John, 2013). They are responsible for delegating the duties to the enrolled nurses, which they are required to perform under the supervision of RNs. The role of RN in delegating the duty has to focus on few questions that can the registered nurse have the skills to safely delegate the duty?, can this activity be performed regularly without decision making or complex observations? Is the health care activity is being performed with knowledge and accountability? And is the registered nurse is monitoring the efficacy of the delegated duty? (Delegation by registered nurses, 2015). Therefore, the role of Registered nurse is to enhance quality of care and health related quality of life of the patients. Supervision is the way of observing, monitoring and evaluating the quality of the delegated duty being performed by the delegated person (Delegation and Supervision for Nurses and Midwives, 2007). Supervision is another significant role and responsibility of registered nurses. The concept behind supervision is to ensure that responsible and reasonable care is being provided to patients. Supervision can be divided in managerial supervision, clinically directed supervision and professional supervision. Managerial supervision states that education, support and guidance should be provided to the individual, who is performing the delegated duty. Professional supervision states that registered nurse should direct the individual performance of those, who are performing delegated duties. Clinically focused supervision is the most important supervision performed by RNs. It requires monitoring and evaluating the outcomes of the delegated duty performed by the individual enrolled nurses or PCAs (Delegation and supervision guidelines for Victorian nurses and midwives, 2014).    Role Of RN In Dementia Care  Dementia is a degenerative disease, which is a kind of Alzheimer’s disease. This disease is caused due to the significant damages in the brain and patient suffers from acute pain and radiating weakness. Dementia can also be considered as the major neuro-cognitive disease (Hugo&Ganguli, 2014). Dementia is significantly diagnosed with the characteristics of the cognitive impairment that includes memory loss, functional decline, and problem in performing Activities of daily life (ADLs). The patient suffers from deteriorated mental skills such as lack of awareness, reasoning, problem solving, information handling and reasoning (Pinzon et al, 2013). Cognitive decline, functional disabilities and memory loss are also the risk factors associated with aging, which can become more severe with dementia. Some of the common behavior and psychological symptoms of dementia are agitation, altered sleep, wandering and resistance to care and also reduced diet (Kolasa, 2015). The role of RN is very significant in providing quality care to the dementia patient, who suffers from functional disability. This neurocognitive disorder can have tremendous consequences for the older people and their care givers (Hugo&Ganguli, 2014).   Dementia affects the functionality of the patients in a very complex manner. The functional decline in dementia patients is due o the cortical-subcortical degeneration (McGuinness et al, 2014). Dementia affects people in different ways. Most of the symptoms are similar in all dementia patients. However, people start losing their ability to think clearly, they have problems with memory and learning, poor concentration, difficulty in living an independent life, problems in following the social cues (Kales, Gitlin, & Lyketsos, 2015). Therefore, the social well-being of the dementia patients is affected, as they are no able to remember people and due to behavioural changes they also lose their social skills. Due to functional decline, the dementia patients also suffer from communication problems. They face difficulty in finding words and often lose their verbal skills (Kales, Gitlin, & Lyketsos, 2015). Dementia is significantly associated with functional decline and some of the other risks factors are also associated with it. According to a study, some significant risk factors associated with dementia are functional decline, which is mainly associated with decrease of independence of the patient and problems in performing activities of daily life (ADL), increased risk of falls and incontinence, difficulty in ambulation (Beddoes-Ley et al, 2016). Dementia also increases the rate of mortality in older patients.   In most of the cases that main assessment of the patients are done by the enrolled nurses. Therefore, it is the duty of registered nurse to monitor the care and evaluate outcomes of the practice performed by enrolled nurses and patient care assistants. Nurses have the significant roles and responsibilities in providing care to dementia patients in community and residential aged care settings (Chenoweth et al, 2014). Such patients require supportive care from the healthcare providers. Physical functioning of the patient is reduced due to cognitive decline that also increases the risk of falls and injuries. Therefore, the role of registered nurse in dementia care is very significant (Sjögren et al, 2013). The registered nurse delegates the duty of fall risk assessment to the enrolled nurse. The correct supervision skills will help registered nurse to monitor the effectiveness of the delegated duty and will also monitor the outcomes and results of assessment. The patient undergoes the enduring changes in the behavior and personality. Incontinence is also a major problem in dementia patients, because such patients lose the sense of control due o he damage in the brain. The RN’s duty is to delegate the activity of helping dementia patient will toileting, changing and helping patient to conduct heir exercise to reduce problem of incontinence (Wagg et al, 2015). Maintaining dignity is the most significant aspect of continence management in dementia patients (Andrews, 2012). Registered nurse provides the frontline leadership in the residential aged care settings. Registered nurse will also be responsible for delegating the duty of caring for the patient. Enrolled nurse will assess the mental condition of older person and also diet of the patients.  Registered nurse can coordinate with the other professionals of the multidisciplinary team and can share the information regarding the patient’s physical, psychological and mental condition. This will help to develop better care plan that can be implemented by delegating the duty to enrolled nurse. It is important to prevent functional decline in the dementia patient, so that they can have independence and better quality of life (Hoogerduijn, Grobbee, &Schuurmans, 2014). For example functional decline can reduce the patient’s capacity to perform activities of daily life (ADL) (Talmelli, 2013), but through proper interventions, RN can help such people to remain independent.   According to the statistics provided by Alzheimer’s Australia (2016), dementia is associated with loss of memory, and also loss of social, physical, rationality, intellect and physical functioning. The burden of care can be high on the family members and care givers as well (Epstein-Lubow et al, 2012). The effects of aging includes loss of memory, social exclusion, increased dependence, impaired mobility, and reduced motor function and significant impact on all aspects of functioning (Talmelli, 2013). The theories of aging are biological, sociological, psychological and moral or spiritual (Sergiev, Dontsova, & Berezkin, 2015). Biological theories explain the physical functioning and physiological process of aging. Sociological theories are associated with the change in social functioning and relationships that can impact the mental and physical well-being of old patients. Psychology of the patients is affected by biological and sociological aspects of patient’s life (Sergiev, Dontsova, & Berezkin, 2015). Registered nurse is in the most appropriate position to identify the social, biological, emotional and psychological needs of old dementia patients. The delegate duty, coordination of care and supervision of the junior nursing staff will be done through critical reasoning and evidence based approach (Flanagan et al, 2014). Cognitive decline, reduce functionality can also reduce the decision making power of patient in end of life (Adams et al, 2011). This is the time when nurses and family care givers can provide supportive care to patient. Supportive care includes providing comfort, pain management, providing comforting environment. Conclusion  This essay is based on discussing the role of Registered nurse in coordinating, delegating and supervising the enrolled nurses and patient care assistance for providing quality and safe functional care to the dementia patient. Essay discussed the role of RN in a comprehensive manner and provides evidence based research for discussing various aspects of quality care for dementia patients. Registered nurses can supervise the enrolled nurses to provide quality care to the patient. Registered nurse has to ensure that delegated duty is being performed accurately and patient outcomes are being improved. Dementia is a very complex disease that can also led to urine and fecal incontinence. Incontinence is the loss of bladder and bowel control. RN has the responsibility of providing respectful and dignified care to patients. RN can supervise the enrolled nurses to talk to patient in a dignified manner and should not make them feel embarrassed. Paper also discussed the theories of aging that impact the functional, social and physical aspects of older patients.  References Adams, J. A., Bailey, D. J., Anderson, R. A., & Docherty, S. L. (2011). Nursing Roles and Strategies in End-of-Life Decision Making in Acute Care: A Systematic Review of the Literature. Nursing Research And Practice, 2011527834. doi:10.1155/2011/527834 Andrews, J. (2012). Maintaining continence in people with dementia. Nursing times, 109(27),20-21. Anderson, D. R., St Hilaire, D., & Flinter, M. (2012). Primary care nursing role and care coordination: an observational study of nursing work in a community health center. Online Journal Of Issues In Nursing, 17(2), 3. e&db=mdc&AN=22686111&site=eds-live&scope=site Alzheimer’s Australia. 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Contemporary Nurse, 52(5), 522-543. doi:10.1080/10376178.2016.1238773 Cashin, A., Heartfield, M., Bryce, J., Devey, L., Buckley, T., Cox, D., & … Fisher, M. (2016). Standards for practice for registered nurses in Australia. Collegian, doi:10.1016/j.colegn.2016.03.002 Chenoweth, L., Merlyn, T., Jeon, Y., Tait, F., & Duffield, C. (2014). Attracting and retaining qualified nurses in aged and dementia care: outcomes from an Australian study. Journal Of Nursing Management, (2), 234-247 Cropley, S., & Sanders, E. D. (2013). Care coordination and the essential role of the nurse. Creative nursing, 19(4), 189-194. Crookes, P. A., Brown, R., Della, P., Dignam, D., Edwards, H., & McCutcheon, H. (2010). The development of a pre-registration nursing competencies assessment tool for use across Australian universities. Retrieved from: Delegation by registered nurses. (2015). Australian Nursing and Midwifery Federation. Retrieved from: Delegation and supervision guidelines for Victorian nurses and midwives. (2014). Department of health. Retrieved from: Delegation and Supervision for Nurses and Midwives. (2007). Australian Nursing and Midwifery Council. Retrieved from: Dementia in Australia. (2012). Australian Institute of Health and Welfare. Retrieved from: Ehrlich, C., Kendall, E., & John, W. S. (2013). How does care coordination provided by registered nurses ‘fit’ within the organisational processes and professional relationships in the general practice context?. Collegian, (3), 127-135. doi:10.1016/j.colegn.2012.04.006 Epstein-Lubow, G., Gaudiano, B., Darling, E., Hinckley, M., Tremont, G., Kohn, R., & … Miller, I. W. (2012). Differences in depression severity in family caregivers of hospitalized individuals with dementia and family caregivers of outpatients with dementia. The American Journal Of Geriatric Psychiatry: Official Journal Of The American Association For Geriatric Psychiatry, 20(9), 815-819. doi:10.1097/JGP.0b013e318235b62f Flanagan, L., Roe, B., Jack, B., Shaw, C., Williams, K. S., Chung, A., & Barrett, J. (2014). Factors with the management of incontinence and promotion of continence in older people in care homes. Journal Of Advanced Nursing, 70(3), 476-496. doi:10.1111/jan.12220 Guideline: responsibilities for direction and delegation of care to enrolled nurses. (2011). Nursing Council of New Zealand. Retrieved from:…/446/…/Nurse_delegation_EN_.pdf Hoogerduijn, J. G., Grobbee, D. E., & Schuurmans, M. J. (2014). Prevention of functional decline in older hospitalized patients: Nurses should play a key role in safe and adequate care. International Journal Of Nursing Practice, (1), 106. Hugo, J., & Ganguli, M. (2014). Dementia and cognitive impairment: epidemiology, diagnosis, and treatment. Clinics In Geriatric Medicine, 30(3), 421-442. doi:10.1016/j.cger.2014.04.001 Kales, H. C., Gitlin, L. N., & Lyketsos, C. G. (2015). State of the art review: assessment and management of behavioral and psychological symptoms of dementia. The BMJ, 350. Kolasa, K. (2015). New Resources for Nutrition Educators: Diet and Nutrition in Dementia and Cognitive Decline. Journal Of Nutrition Education And Behavior, 47402.e7-402.e8. doi:10.1016/j.jneb.2015.02.011 McGuinness, B., Craig, D., Bullock, R., Malouf, R., & Passmore, P. (2014). Statins for the treatment of dementia. The Cochrane Library. Pinzon, L. C. E., Claus, M., Perrar, K. M., Zepf, K. I., Letzel, S., & Weber, M. (2013). Dying with dementia: symptom burden, quality of care, and place of death. Deutsches Ärzteblatt International, 110(12), 195. Sergiev, P. V., Dontsova, O. A., & Berezkin, G. V. (2015). Theories of aging: an ever-evolving field. Acta Naturae (???????????? ??????), 7(1 (24)). Sjogren, K., Lindkvist, M., Sandman, P., Zingmark, K., & Edvardsson, D. (2013). Person- centredness and its association with resident well-being in dementia care units. Journal Of Advanced Nursing, (10), 2196. Talmelli, L. F. D. S., Vale, F. D. A. C. D., Gratão, A. C. M., Kusumota, L., & Rodrigues, R. A. (2013). Alzheimer’s disease: functional decline and stage of dementia. Acta Paulista de Enfermagem, 26(3), 219-225. Wagg, A., Gibson, W., Ostaszkiewicz, J., Johnson, T., Markland, A., Palmer, M.H., Kuchel, G., Szonyi, G. and Kirschner?Hermanns, R., 2015. Urinary incontinence in frail elderly persons: Report from the 5th International Consultation on Incontinence. Neurourology and urodynamics, 34(5), pp.398-406.

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