Here is one that was given by one of our PhD candidates in her own workplace in Australia. I know I could identify many attributes of person-centeredness in what she spoke about and how she spoke. Hope you enjoy the read and photos. Thank you Kelly for sharing your speech Jan Dewing
Thank you to the University of Wollongong Student Nurses as Professionals (SNAP) group for hosting today and for the invitation to speak today at this International Nurses Day Breakfast. I am so grateful for the opportunity to share my vision and passion for health for all.
I am passionate about thoughtful and considered care of all persons as I know all of you are here, as you have chosen to be here celebrating the best profession there is. In particular I believe in the dignified and healthful care of older people. Even as an undergraduate, I enjoyed and sought after the care of older people. I wasn’t brave enough to tell my peers at the time, it wasn’t a glamorous part of nursing to go in to. But here I am. Knees deep in a PhD and five years recently dedicated solely in aged care nursing in a residential aged care facility. I find it a true joy to work with older people. I love the people I meet and finding how they fit in their family, the community and how they have left their mark on the world. I have seen and heard of beautiful everlasting love stories – better than those in any fairy tale. I have heard about how much one person has had to endure in their lives and then they live despite it all. I have seen people be at their loneliest, most emotional and at their happiest. I have seen people be truly content when they reflect upon their life journey.
When I think of this years theme for International Nurses Day “Health For all”, my thoughts turn to the recently heard and broadcast stories about ill-health that is experienced by the older people in care within Australia. As a nurse who has worked in the aged care sector, I can tell you that the nurses there are doing their best. Its tough. And the system is at breaking point. We are failing at maintaining the health and wellbeing for our older Australians.
As a registered nurse, imagine: being the sole in charge of a large facility after hours, and being responsible for the care of somewhere between 80-110 residents, also supervising and providing leadership for somewhere between 7-10 care support workers, overseeing medication, managing polypharamacy, mitigating risk and responding to incidents. Wow. What level of caring can realistically be provided in this environment? Does this provide the best framework for healthful care?
And the Royal Commission into Aged Care Quality and Safety is welcome, but it’s too late. It’s too late for the person who was attacked and murdered by another person in an aged care facility. Its too late for the woman whose dentures were found to be rotting in her mouth after months of poor oral care. It’s too late for the man whose wandering was deemed so problematic that he was strapped to a chair and medicated with antipsychotics day in and day out until his family barely recognised the man folded over and drooling on himself. I’m sure this doesn’t sound like health to any of us.
Health is about wellbeing; both physically and mentally. Being able to live the life that you choose, having hopes and dreams for the future. Our liberty.
So how sad that we have diverged so far away from this concept of health and wellbeing in what is packaged as residential “care”.
So how did we get here? We know that people who move into care now are older and more frail. This is because we have recognised people want to and have been staying at home longer with in home support. But when they move into a care environment their health needs are more complex, and their needs change and evolve over time. As it does. The average age of people moving into care now is around 90 years old. And then emphasis for these older people has been is on existing and meeting basic human needs, is this living?
What do we really think about getting older? What are our views of older people? How do we feel about them in society? We have legislation, policy and procedure, rules, regulations and mandatory reporting focused on the protection of older people and they are labelled in society as vulnerable people, who need our protection. Who decided this?
Funding for the ongoing provision of people placed in care is awarded on the basis of inabilities. So, on what older people cannot do for themselves. Which then becomes the focus for all health professionals who come into an older person’s life when documenting, assessing, interacting and caring for older people. Funding increases are directly associated with decline in capability. And so consequently this doesn’t allow for any focus on enhancing, rehabilitating and promoting health and capabilities of older people. No funding is awarded for any curative, or rehabilitative caring practices in residential care.
How we equip the workforce in the aged care sector also deserves a closer and more considered look. We have a workforce that is largely vocational, undervalued, underpaid, unregulated and under-resourced. Most not even being offered the specialised training, skills or ongoing support that is needed in careful health care provision.
Two out of three nursing homes are understaffed, so every measure that is taken and decision made is based on being risk averse and protecting people any cost. And so we have seen this evolution of restrictive practices that are used, and the justification here is safety. These restrictive practices come in the form of physical restraint; holding a person’s limbs to stop them from moving, using lap belts or leg, ankle wrist or vest restraints, using bed rails, locking over bed tables. Seating people in chairs with deep seats or reclining chairs that they cannot stand up. Or removing people’s sticks and frames altogether, so they don’t fall or because we perceive they could be used as a weapon. We have all been privy to these practices. This also includes confining a person to a secure or locked unit; why does a diagnosis of dementia mean we can violate people’s human rights and lock them up against their will, without their consent? What a complete deprivation of liberty.
And what about chemical restraint? We use the excuse of treating symptoms and doctors to prescribe mood stabilisers to help the mind, emotions and behaviours of the person. But we have to ask ourselves if this is promoting health. Are we just in fact restricting a person’s movement and their ability to make decisions? Does this really sound like health?
Can you imagine in the near future, when we have twice the amount of older people in our society who will be accessing aged care services, and this is what we have to offer?
These are profound problems in the aged care sector. But we can be part of the solution. And for me, promoting health and human flourishing for older people can be achieved. I am truly optimistic about the future of the care of older people in residential care. And I stand here, full of hope that we can get there and we can do this. And on this international nurses day, I am using my nursing voice to lead. So, come with me, hear me and imagine what the health of older people looks like. After all, I hope we all have the privilege of growing older.
Imagine there was value and emphasis placed on nurses building meaningful relationships with older people in care, what would that look like as a quality indicator? Isn’t this of greater profit? What if time spent talking with an older person was seen as important as a daily shower. What if nurses in aged care received the support to develop and consolidate skills and knowledge to cultivate person-centred practices. And they learnt that challenging behaviours weren’t actually symptoms of dementia, but were in fact symptoms of unmet basic human needs. That the reason a person is wandering outside is because they are trying to find something familiar. Or someone asking to go home actually just means “I want to feel safe”.
When we are planning for the day to day care of an older person and we document this, imagine if the emotional and psychological wellbeing were as regularly planned for as pressure area care is. That the ability to outside and feel the sunshine on your face and wind in your hair was as regimentally scheduled as your shower. The connection and appreciation of nature is vital to us all.
Imagine we centred our focus on creating a culture within aged care where we learn about people, and in service titles were the names of residents. That we didn’t learn about illness, disease and vulnerability in isolation of each other. That we learnt about people, their experiences and how they have left their mark on the world. To truly see them.
I would like to leave you with a vision of aged care being a place where life is lived by older people. Where the focus is not on palliation and end of life. Where liberty, hopes, dreams and plans for the future is the thread of the fabric of care that we weave. Where we continue to nurture health and the human spirit. My call today is to join me, in a vision of true living and health for older people. We can start today, be the difference, see who the person is behind that resident, client, patient in front of you.