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pharmacist. There are also a range of practical interventions to promote adherence to medication that can be used, depending on the needs of the patient (Box 6.5).
Box 6.5 Examples of interventions to increase adherence to medication
•
Care planning with the older patient, family and/or significant other•
Coordination with the interdisciplinary team•
Multifaceted education on medications in conjunction with the pharmacist using appropriate and age-specific educational materials•
Promoting awareness of side effects, adverse reactions and how to seek advice•
Use of reminders (e.g. written reminders, phone calls or alarms)•
Use of aids (e.g. pill or dossette boxes, blister packaging and medication-dispensing systems)•
Monitoring medication-related behaviour•
Regular medication reviews•
Self-administration of medication programmes•
Discharge planningVisit www.wileyfundamentalseries.com/medicalnursing and read Reflective Question 6.2 to think more about this topic.
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for those at risk of falling (Box 6.7). These should be individualised to the needs of older patients and acceptable to them, and should also involve members of the interdisciplinary team working in a planned and coordinated manner.
Conclusion
Although the majority of older people live at home and enjoy good health and an active life, as with all age groups, the need for acute care is always a possibility. For older persons who have one or more
Box 6.6 Examples of risk factors for falls
Intrinsic risk factors Extrinsic risk factors
Age
History of falling
Elimination difficulties, e.g. incontinence or nocturia Postural hypotension
Gait and balance disorders
Sensory difficulties, e.g. of hearing and sight Frailty
Cognitive impairment Muscle weakness Cardiac arrhythmias
Environmental hazards:
•
Poor design•
Poor lighting•
Varifocal spectacles•
Clutter•
Bed/side rails•
Slippery or wet floors•
Footwear and clothing•
Unfamiliar environments Medication issues:•
Certain medications, e.g. diuretics, antihypertensives and sedatives•
Use of four or more drugs•
PolypharmacyBox 6.7 Examples of interventions to prevent in-hospital falls
Care planning and intervention:
•
Risk assessment using valid and reliable tools•
Involvement of the older person and family or significant others•
Assistance with activities of living•
Interventions to compensate for reduced sensory, cognitive or functional abilities•
Use of policies relating to the use of bed rails and restraints•
Discharge planning to include maintenance of bone health and education for the prevention and management of falls•
Provision of written information Promotion of a safe environment:•
Assessment and modification of environmental hazards•
Nursing the patient within view of the nurses’ station•
Properly fitting clothing and footwear•
Ensuring that beds are at their lowest level and that their brakes are functioning•
Ensuring that the call bell and personal belongings are within reach•
Patient identification and (with permission) the use of fall detector technology, in line with hospital policy•
Staff education and development88
Now visit the companion website and test yourself on this chapter:
www.wileyfundamentalseries.com/medicalnursing
chronic conditions and increasing frailty, the likelihood of hospital admission is higher. We believe that all acute care nurses consequently require an age-appropriate value and knowledge base along with the competence to deliver skilled nursing care to older people. This will involve an understanding of the effects caused by the interrelationships between age-related changes, comorbidities and syn- dromes seen in older age (Inouye et al. 2007). To this end, this chapter has provided an overview of the principles underpinning dignified and respectful nursing care for older people, and has explored some of the clinical issues that are a particular priority when caring for older patients in acute care settings.
References
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Competencies for Care, 2nd edn (pp. 260–83). Boston: Jones & Bartlett.
Cohen-Mansfield, J. (2000) Use of patient characteristics to determine nonpharmacologic interventions for behav- ioural and psychological symptoms of dementia. International Psychogeriatrics, 12(1):373–86.
Cowdell, E. (2010) The care of older people with dementia in acute hospitals. International Journal of Older People Nursing, 5(2):83–92.
Department of Health (2001) Medicines for Older People: Implementing the Medicines-related Aspects of the NSF for Older People. London: Department of Health.
Eliopolous, C. (2010) Gerontological Nursing, 7th edn. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.
Elliott, M. & Liu, Y. (2010) The nine rights of medication administration: an overview. British Journal of Nursing, 19(5):300–5.
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Fulton, M. & Allen, E.R. (2005) Polypharmacy in the elderly: a literature review. Journal of the American Academy of Nurse Practitioners, 17(4):123–32.
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Principles of end of life care
Kevin Connaire
Centre for Continuing Education, St Francis Hospice, Dublin, Ireland
7
Contents
Introduction 91
The nature of dying 91
Comfort at the end of life 91
Communication at the end of life 96
Ethics and end of life care 99
Conclusion 101
References 101
Having read this chapter, you will be able to:
•
Describe the nature of death and dying•
Describe the main symptoms in the dying process•
Gain an appreciation of the communication needs of the dying person•
Discuss a variety of methods that may be used when communicating with a dying person•
Appreciate the nature of loss for families of a dying person•
Describe the ethical challenges surrounding the administration of nutrition and hydration to a dying personLearning outcomes
Fundamentals of Medical-Surgical Nursing: A Systems Approach, First Edition. Edited by Anne-Marie Brady, Catherine McCabe, and Margaret McCann.
© 2014 John Wiley & Sons, Ltd. Published 2014 by John Wiley & Sons, Ltd.
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Introduction
Death is an inevitability that each person faces in their lives. It is a part of living that brings with it many challenges, not only for the person who is imminently dying, but also for the family and staff who are caring for the dying person. Many patients who are dying face numerous losses, which may be gradual or acute, depending on the disease trajectory. This is a time of stress not only for the patient who is dying, but also for the patient’s family as they come to terms with their impending loss. It is not uncommon for the patient who is dying to feel lonely and isolated, which heightens the need for members of the multidisciplinary to increase their skills of sensitivity to each individual situation.
Having an awareness of these situations potentially adds to the quality of care for the patient and the family members.