Caring for Older People in Nursing

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Sue Barker

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    About the Authors

    Dr Sue Barker is a registered mental health nurse and chartered psychologist; she works at Bournemouth University in the School of Health and Social Care as a senior lecturer. She is also a member of Bournemouth University Dementia Institute. As part of this she has undertaken consultancy and evaluation work. She has a particular interest in mental and emotional well-being and her PhD explored the emotional care given to women becoming mothers. Sue leads a unit on the mental health nursing programme entitled mental health and well-being in later life.

    Michele Board is an adult nurse and has had a broad range of clinical experience, from ward sister to senior nurse, always with a specific focus on nursing the older person. She started lecturing in 2003 on the undergraduate nursing programme, and specialised in themed days on the nursing care of the older person and dementia care.

    Michele was appointed as the associate director for the Dementia Institute in February 2013. Since then she has taken the lead in the development of dementia education programmes for health and social care staff working in the NHS and private-sector education.

    Michele is also a fellow of the National Institute for Health Research (NIHR) School for Social Care Research, where she is contributing to a research project with the universities of Cambridge, Worcester and York. The aim of the research is to gain a better understanding of how to meet the care and support needs of older people with concurrent sight loss and cognitive impairment and who are living in housing settings (as opposed to care homes).

    The research with the NIHR ties in well with Michele's PhD, which she in the process of writing. Her PhD has looked at the meaning of home for baby boomers using an interpretive visual methodology.

    Karen Cooper qualified in 1978 and has over 30 years’ clinical experience within medicine and care of the older person. Karen was a ward manager for ten years in a rehabilitation setting for older people. She moved into education in 2005, initially as a practice educator, and is currently a lecturer in adult nursing. Her areas of academic and research interests are in practice learning, assessment and mentorship in relation to practitioners’ personal and professional practice.

    Dr Lee-Ann Fenge is Deputy Director of the National Centre for Post-Qualifying Social Work at Bournemouth University. She is a qualified social worker, and has worked in both hospital and local office settings with both adults and children. She has extensive teaching experience at both undergraduate and postgraduate levels. Her research interests concern inclusive research methodologies for engaging with seldom-heard groups, old age and sexuality, and the impact of the recession on older people's well-being.

    Rosalind Green is an associate researcher at Bournemouth University and Alexander Technique teacher by background. Her work focuses on the promotion of emdodied knowledge in relation to using the Technique specifically in reduction of background ‘noise’ when riding. Her work with a variety of adults and children has led to a specific interest in developing a model in which to promote people's understanding of what they are doing with themselves.

    Sarah Hean is an associate professor within the well-being and health academic community at Bournemouth University. She is an educational researcher by background, with a keen interest in interprofessional and collaborative practice and learning, specifically that which enhances the quality of life of older people.

    Vanessa Heaslip is a senior lecturer in adult nursing; her clinical background was as a district nurse and specialist practitioner for older people. She is aligned to the society and social welfare academic community within Bournemouth University, due to her research interests in hearing the voices of marginalised communities and minority groups. Reflective of these interests, she also sits on the national Mary Seacole award steering group as an independent member, supporting awardees working on projects to enhance the lives of people from ethnic minorities.

    Vanessa is also a member of the Bournemouth University Dementia Institute, and works with colleagues providing educational programmes to staff within a variety of clinical settings, challenging them to see beyond a diagnosis of dementia towards seeing the person, as well as developing their understanding of vulnerability. Vanessa has written extensively around the concept of vulnerability, including co-editing a book on vulnerability, and believes that addressing vulnerability is a core aspect of high-quality nursing care.

    Dr Ann Hemingway is public health research lead with the Academic Centre for Health and Wellbeing at Bournemouth University. Her interests focus on the promotion of sustainable well-being through resident involvement in planning and providing services; and capacity building, particularly in deprived areas. A principal aim of this work is actively to involve residents in well-being improvement and evaluation work. Her career over the last ten years has consisted primarily of managing national and international research and development projects. Ann is guest lecturer in public health/public health nursing at Uppsala University in Sweden and Chair of the European Academy of Caring Science. She is also a member of the leadership group for the UK chapter of Sigma Theta Tau, the international Scholarship Honour Society for Nurses.

    Eleanor Jack is an associate lecturer in mental health nursing at Bournemouth University and a member of the well-being and health academic community there. She is an adult and mental health nurse by professional background at junior and senior levels within primary, secondary and tertiary care settings and has also worked as a researcher on a wide variety of research projects for the university since 2001. Eleanor has a keen interest in promoting salutogenic approaches to health and empowerment within the nurse education curricula.

    Dr Janet Scammell is an associate professor and registered nurse and works for the School of Health and Social Care at Bournemouth University. Her role is professional lead for adult and children's and young people's nursing. Janet is a member of the Mary Seacole award steering group and has mentored several successful awardees over the years. After a career in nursing practice, Janet moved to higher education and has over 20 years’ experience as a lecturer and educational leader with undergraduate and postgraduate students in nursing. Janet also facilitates interprofessional education for health and social care students and has led research projects in this area. Janet's current research interests include ethnicity and healthcare practice, including workforce considerations, nursing older people, practice learning and humanisation of care.

    Sue Smith Now retired from full-time employment, Sue Smith is the principal carer for her 87-year-old mother and has an adult son who has a severe learning disability. She has been involved in multiagency communication within both learning disability (for 37 years) and elderly care (for some 10 years). She worked for over 20 years as public relations/fundraising manager and parent liaison coordinator at the school where her son attended, with some additional involvement in new admissions and marketing. She has been part of the Bournemouth University Carers and Service Users Programme almost since its inception and has enjoyed enormously the variety of opportunities involving prospective social work students. Most recently, she has been involved in end-of-life care for her mother-in-law (diagnosed with advanced, aggressive lung cancer) within a nursing home situation which, although extremely emotional, was nevertheless an experience she felt privileged to be involved in.

    Acknowledgements

    Sue Barker thanks all at Learning Matters for encouragement, support and patience, particularly Caroline Sheldrick, who has responded to queries quickly and shown sensitivity and support for the authors.

    Ann Hemingway would like to thank all the retired nurses who contributed to the discussion about well-being in caring settings included in Chapter 4, for their time, enthusiasm and thoughts.

    Eleanor Jack would like to express heartfelt thanks and gratitude to the members, volunteers and staff of the Brendoncare Friendship Clubs who not only gave their time but shared their personal experiences and narratives so freely. During the reflexive and reflective processes inherent within this study, Eleanor was often moved by the sincerity and humility of what she felt privileged to read, hear and see. Much of that experience has informed the writing of her chapter. Grateful thanks go to her mentor Dr Ann Hemingway.

    Janet Scammell would like to acknowledge the contribution of four undergraduate nursing students for their case studies in Chapter 8 concerning ageing and care in countries outside the UK. They are: Irina Pavalache; Ida Ngwa Azinnwi; Jitka Mulackova; and Pooja Gurung.

  • Glossary

    Adaptive/maladaptive strategies

    Strategies or ways in which people do things that are either helpful and do not cause them extra problems (adaptive) or that do cause them extra problems (maladaptive).

    Agency

    A person's ability to act or do something.

    Autonomy

    A simple description reflecting the ability of an individual to make an informed choice without any form of coercion, usually with regard to choices to be made regarding the person's life and current circumstances.

    Black and minority ethnic (BME) groups

    Minority ethnic groups are all groups excluding white British.

    Culture

    Symbolic concept that embodies values, lifestyles, manners, customs, food and dress and is connected with the construction of group boundaries.

    Dehumanisation

    Process by which people are removed of their personhood and simply seen as objects or tasks.

    Directive

    Philosophies of leadership and team working characterised by a need for a hierarchy within a team and a clear leader.

    Discrimination

    Treating a person or group differently (often negatively) because of a particular attribute such as age, race or sexuality.

    Disempowerment

    A process by which people are deprived of power and choices regarding their lives and treatment.

    Elective

    Philosophies of leadership and team working characterised by professionals who prefer to work autonomously and who refer to other professionals only when they perceive the need.

    Emic

    Internal perspective of something or someone.

    Emotion-focused

    Where feelings are focused on or are the central point.

    Emotional isolation

    Commonly described as when individuals feel there is a lack of intimacy and meaningful attachments within their life.

    Equality

    When everyone has the same or nearly similar chances to achieve their goals.

    Essentialism

    The belief that social differences are determined by biology.

    Ethnicity

    Actual or perceived common ancestry, language and regional or national origin.

    Ethnocentrism

    Judging other cultures by the standards of our own on the understanding that our own culture is superior.

    Etic

    External judgement of something or someone.

    Homogeneous

    Simply put, this means alike or of the same kind. The assumption is that everyone within a particular social group are all the same and have the same interests.

    Horizontal substitution

    This occurs when roles are interchangeable between professionals of similar training level.

    Humanisation

    A framework designed to help ensure that all those we care for are treated as human beings.

    Humanising values framework

    A structure for care that focuses on what is important to the individual as a human being.

    Infantilisation

    A process in which adults are treated as if they are children.

    Integrative

    Philosophies of leadership and team working characterised by views that collaborative working and being a team player are central to interprofessional team working.

    Loneliness

    An awareness and discomfort due to a lack of social support or contact.

    Mind maps

    Diagrams exploring different ways of viewing the world.

    Monotonous

    Always the same, not exciting, boring.

    Organic

    Of or relating to living matter. In this context, ill health that has a physiologically identifiable cause.

    Paternalistic

    Thinking that you know what is best for individuals and therefore not consulting with them or enabling them to have a choice regarding their life; making decisions for others without consulting them.

    Private sector

    Organisations funded privately (e.g. private healthcare companies).

    Problem-focused

    Dealing with a challenge or difficulty by attempting to resolve it.

    Psychometric tests

    Assessments or measurements of psychological functioning which can involve personality, intelligence or illness.

    Public sector

    Organisations funded by the state (e.g. social services).

    ‘Race’

    The scientific concept, not now accepted, of the ability to divide up humans on the basis of their different physical attributes.

    Racism

    Attitude that one ‘race’ (group perceived as different based on appearance or place of origin) is superior or inferior to another.

    Recovery approach

    The focus of care or support on the process individuals go through/the journey they take to move forward with their life to return to a state of well-being.

    Shared or distributed leadership

    A model in which all can contribute to the leadership task where and when their expertise and qualities are relevant.

    Social exclusion

    Where a person or group of people cannot access the opportunities or rights that are generally available to the society they live in, including housing, education and employment.

    Social inclusion

    The positive effects of those measures that are taken to result in a change in circumstances and/or habits that mitigate against social exclusion, thus enabling people or communities to participate fully and meaningfully in society (http://www.charitycommission.gov.uk/media/95497/socinc.pdf).

    Social isolation

    Commonly described as an objective assessment of an individual's social network, where there are perceived to be few actual contacts or opportunities to meet others and little involvement in community life or the wider social environment. It can also be used to infer living arrangements (e.g. living alone) or the lack of friends.

    Solitude

    A term commonly used to describe the positive state of being alone by choice, for the purposes of inner reflection and enjoyment.

    Stereotyping

    Assuming that individuals are the same as others in their social group, e.g. all older people are the same because they are old, and therefore have the same attributes (e.g. confusion, incontinence) or enjoy the same activities (e.g. bingo).

    Subjective

    A view or way of looking at something based on an individual's personal feelings, tastes or opinions.

    Third sector

    Not-for-profit organisations, often with charitable body status; also called the voluntary sector, e.g. age-related charities.

    Vertical role substitution

    Occurs when tasks traditionally done by one profession are delegated to less qualified professionals.

    Visuospatial

    The visual processing of the relationship between objects, the space between them. How people see objects within the environment.

    Welfarism

    Process by which individuals are automatically assumed to require assistance simply because they are old or have a disability.

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