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Nursing Home Placement Term Paper


1.0 Introduction
As population ages and the number of people with disabilities increases, the need for long term care also increases. Palliative care is one of those health care sections where supply has not met the demand for long term care. There are people with medical conditions that are complex and labor intensive like obesity, dementia and behavioral health conditions. Long term care takes into consideration home and community based settings with an aim of serving even complex medical conditions.

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Nursing placement in a nursing home has largely changed my perception on community nursing practice. Elderly people are known for their fear in being admitted in nursing homes since they think that they are losing their independence and identity. They often show rebellion because the right of making their own decisions has been taken away from them. Care givers are responsible of helping them to cope with such strains. The elderly also need to be helped by caregivers on how they can build some social networks in nursing homes.

This paper reflects on my personal experience in a long term care (nursing home) where I had been placed as a nursing student. In the nursing education, practice based learning has been essential and quality of the clinical experience has heavily influenced it.

2.0 Literature Review
Ageing population requires nurses to develop clinical skills that adequately meet older people’s needs in various settings. There is also an increase in the need for placement of higher quality of student nurse so that they can achieve practical skills. Similarly, there was a shift in health care from the long hospital care stay to a shorter-stay model that raised the demand for nursing homes so that they can meet this demand. Placements that are hospital based experience shortages which have been a major global challenge for nursing education. It has resulted to an increase in nursing homes usage internationally.

Nurses that works in such environments have felt valued in coming up with a learning environment that positively impact student nurses. Nursing homes are perceived as just providing basic care without developing any specialist’s skills. Staffs need to recognize their work as skilled experts and this can influence how they convey such abilities to students that can in turn influence the perception of the student delivering care.

When nursing students undertake placements in several elderly care settings, it becomes effective in their preparation of ensuring that they delivering care that is on another level. There are some undesirable elements in the placement of a nursing home that can be looked at so that the experience can result in positive perception of caring for the elderly as a career.

Personal encounter
During my placement in a long term care home, I had the responsibility of ensuring that the residents live comfortably and independently. I assisted residents with medication administration of different drugs. At first I thought it would be an unsatisfactory experience caring for older people. I did not think there was much to learn and that I would end up being detached from my learning experience. These thoughts came from some assumptions that I had made of spending most of my time in helping residents with their activities of daily livings rather than furthering my clinical skills and nursing knowledge.

I had two significant experiences that changed my perception. It was challenging for me to administer medication for 33 residents every morning and afternoon and still manage others who were yelling out at me. There were some who would ask questions repeatedly and others who were so impatient with the entire process. There was this time that I almost administered the wrong medication to a resident who was attached to a different student nurse. This I did after talking to one of the workers who misguided me into assuming that she was who I thought she was. Just before I administered the medication I saw my preceptor walk by the room, and I decided to confirm with my preceptor if she was the right patient. Had I not seen my preceptor at that moment, I most likely would have given the resident the wrong medication.

I discovered a few ethical issues while on placement; I learned that it was vital to deliver quality care and to always remain motivated. I also learnt that the treatment that is provided by these nursing homes has a major effect on individuals since they are more vulnerable. These residents have more than one need that ranges from prevention of pressure, ulcers to maintaining tube feeds. There are other decisions also one has to make like whether to allow a certain resident to leave the room alone or with company. There is need to know why we do certain things and how we can do them well.

I realized that some of the learning had to be done on the job since there is always new information. Practice can also help one to know how something can be done and how to improve a certain skill. My education has helped to promote creativity and flexibility.

In my recent experience, I was caring for an older person on palliative care. Just before she passed on, I assessed her rapid respiration, the color of her pale skin, and the faint beat of her heart (witnessed the changes in the dying process). I was very nervous because a few family members were watch me, and I did not really know what I was doing. It was also emotionally hard on me, as I had never cared for someone at the end of their lives that led right to their death. It was very hard for me to look strong for the family because I started to think of my aunt who was battling cancer, and what her end time might look like (Wilson, Morbey, Brown, Payne, Seale, & Seymour, 2015).

Relevant Factors in Palliative Care
Palliative care focuses on the relief of physical as well as existential suffering and elderly patient’s life support and their caregivers. Palliative medicine is administered at the same time as any other medical care and needs to be offered simultaneously with other treatments that are known to prolong life. Troubling symptoms are assessed and appropriate relief provided which goes hand in hand with communicating with patients about the treatment plan and the goals to be achieved (Brunnhuber, Nash, Meier, E.Weissman, & Woodcock, 2008). The palliative care for older people has been changed because of the higher proportion of the elderly. Many elderly people die under the care of nursing homes and this has necessitated proper implementation of palliative care in that context.

I learnt from the experience that I had of taking care of a resident on palliative care that intensive treatment is needed. In this particular experience, the residence was her final stay. I felt that supportive care was needed and expertize help would have been more appropriate. I benefitted from this exposure because I realized that residents have serious illnesses that are not clearly terminal. I also felt that the patient should have been hospitalized or made to access treatment from skilled nurses.

Such Residents can also consult to access palliative care which can help them in managing their symptoms, give them spiritual and emotional support as well as a plan as they come to the end of a life. This will help them not to waive other medical benefits.

Underlying issues
There is little information on the challenges that a certain medical condition may present to admission in nursing homes. In nursing homes the issue of drugs is very serious, as a student nurse I had to be very careful on how I was administering medication. Moreover, there are programs like CMS that aim at reducing antipsychotic medication from being used thus requiring nursing homes to review their practices (Canningham, et al., 2016).

The social considerations that I observed from these two experiences were that: residents consider their experiences in the nursing home as compulsive and degrading. They see as if their determination to live is at risk since they have to depend on the process of nursing care that is given daily. When residents are made to wait for help and support, they feel powerless. They lack a proper setup that they can associate home with since there are no private rooms. In resident’s private setup (in their home) there are clear boundaries unlike in nursing homes where these boundaries are blurred.

When residents are in a nursing home, any social contact is perceived differently. This denies them the opportunity of being a part of the society outside these homes. They miss contact with their family members and friends that they had in their earlier times. A nursing home providing for such needs demonstrates appreciation and respect for the residents. However, the contact between residents in nursing homes and their families grows distant after they are moved in a nursing home. The reasons behind it, is the family lack of interest and avoiding the discussion of their disease. Residents in nursing homes have also discouraged family members to pay them visits in such a helpless state (Canningham, et al., 2016). They see as if their own dignity is at risk because they observe how other residents are increasing the need for care.

The dignity of the residents is tied on social relationships but establishing a good relationship with other nursing home residents has proved to be challenging. Residents require the support of nurses to enable them establish interpersonal contacts but this support is inadequate. They define their staff as people whose only concern is maintaining order and discipline. They spend most of their task performing their administrative tasks. There lacks a social relationship between them and the residents, they just turn out to be unfriendly and inactive. These feelings of dislike and disinterest are expressed towards residents.

According to Canningham, residents in nursing homes always complain that there is very little attention given to independence. The motives that these elderly people have of remaining active are handled insufficiently (Canningham, et al., 2016). Residents choose to remain inactive rather than using their own capabilities since they feel that their efforts may not be recognized. There is less time for them to raise the standard of residents in nursing homes instead they show over-compliance. They show a subordination that is of high level to all the staff thus dismantling their own competencies. This result is an increase in mental and psychological disorders that forces residents to withdraw socially and lose their identity. Residents struggle with maintaining independence and establishing their social identity while they are still in the nursing homes. Petzold theory handles the concept of identity adequately (Johanne, Sekse, Hunska, & Ellingsen, 2017).

Identity theory
Petzold describes identity as answering questions like “Do I belong to somebody?” a person gains identity by being able to distinguish himself in the existence of real perceptions. He/she has a self-identity that can be recognized by other people who are in the same environment. The personality of a human being is developed through social relationships. Developing the identity of a person requires merging stories, a series of activities, and conversation with others. In the course of life, people we have conversation with change and our life situations are bound to change. Identity should be seen as a process that constantly changes, so its formation never changes (Wilson, Morbey, Brown, Payne, Seale, & Seymour, 2015).

Identity is subjected to considerable changes that happen in a person’s life. Such changes include changes experienced in the body as well as living environment alteration that happen as a result of aging. The elderly live in the past that is why they like telling stories from their past. Recalling about the past and being in that thinking state and reflecting means that content about long term memory will materialize. Some of their stories are helpful in stabilizing identity as they generate their sense of living.

In each story, all identity that forms the elements composed of a story suffers from cerebral as well as mental processing. This provokes a personal identity that changes constantly with no end. The personality of a human being grows in social relationship that includes 5 core areas namely: body, performing a task/free time, values and material securities. A person’s individual experiences that they consider important are shared with other people. People who share their experiences and tell their stories play a big role in in influencing their future identities (Canningham, et al., 2016).

In nursing homes, the level of strains that is placed on residents is quite high because of undesirable acknowledgements and social depravity. The weakening of social identity causes real identification to be forgotten. When identity is breaking down, resident start showing that their performance is deteriorating. They feel emotionally exhausted and their self-worth is in jeopardy.

2.1 Admission into nursing homes
The ageing process is characterized by some critical changes that happen in one’s life like when close dependents die, health issues increase thus requiring more care. People who have been moved into a nursing home experience changes that prove to be stressful. Admission into a nursing home is contributed to by significant events and turning points in their lives. The nursing home is not able to meet the requirements for training due to its cost, thus motivation is decreased. Nursing homes are at liberty of turning down new residents especially when they feel that they cannot meet the needs of the individual. To residents, this turns out to be a huge barrier to finding a home that can accept them and take care of their needs.

This also has a change in their social status, a feeling of homelessness, changing their social contacts, autonomy impact and their habitual activities are reduced. The adaption is made harder and an individual has to take 3 to 6 months. Research indicates that nursing homes are responsible of shortening residents’ lifespan. About 22% of residents do not survive their 6 months in the nursing home (Brunnhuber, Nash, Meier, Weissman, & Woodcock, 2008). They are dependent on the care givers to have their needs met.

There are certain medical conditions that are challenging when residents are placed in nursing homes. The main categories are behavioral/psychiatric disorders, need for complex care, dementia and obesity. Behavioral or psychiatric conditions are the greatest challenge for people placed in nursing homes. There are other cases of psychiatric disorder if the patients also suffer from dementia. Complex care needs is also another challenge where care for wounds is taken, feeding tubes, IV antibiotics, dialysis or tracheostomies. These residents often require intensive cares from staff hence nursing homes are usually reluctant to take them (Brunnhuber, Nash, Meier, Weissman, & Woodcock, 2008).

In general, medical non-compliance is also an issue where residents seek care only when they are faced with a crisis instead of receiving preventive and maintenance care from time to time. These residents lack routine care that intensify chronic conditions leading to the need for nursing home care and this would have been prevented. Patients with these disorders find it hard to get a placement in nursing homes.

Skills Learnt in Aged Aare Setting
Before placement, nurse student have undesirable perceptions about the operations of nursing homes and giving care to the elderly people. However, they fail to recognize that there are available educational opportunities at their disposal. Research has reviewed student nurses that have worked as health care assistants in a similar setting but they have not viewed them as learning environments (Johanne, Sekse, Hunska, & Ellingsen, 2017). Nursing homes have been known for providing an environment that is supportive exerting less pressure on the clinical staff, and allowing more time to students to strengthen staff-patient relationships. This is beneficial in enhancing the basic skills in nursing as well as developing desirable attitudes towards older people. The considerable shift in attitude and perceptions help in acknowledging the opportunities available to them. An important concept that has been identified in nursing homes is that they are “nurse led” which is an essential concept for student nurses to explore.

Nursing homes provide opportunities for students to learn, practice and master basic nursing skills. Students engage in useful practice of bathing, feeding and dressing residents. These task need to go beyond just performing them to something that can really educate, comfort and express care. Anatomy can be learnt here, as well as physiology and skin integrity. Holistic nursing care is also a skill offered including personal skills that are learnt when one communicates with family members and other staff (Brunnhuber, Nash, Meier, Weissman, & Woodcock, 2008).

The demands that student place on clinical staff need not to be underestimated. There is pressure in competing priorities where clinical staffs try to meet both patients’ and students’ needs. This is something that is also evident in the private sector nursing home provision in the commercial world. The financial consideration cannot only affect the quality but the quantity as well of clinical staff that mentor students. When maintaining financial viability becomes a struggle in nursing homes as well as recruiting appropriate staff, chances for taking in student nurses placement becomes limited. Medical needs in nursing homes are increased by some conditions like dementia, obesity and behavioral health needs. This is because these conditions require equipment that are specialized, staffing, training and services. If these challenges are done away with, nursing homes become a perfect source of experience from working with the elderly.

In other places like in the United Kingdom, student nurses are taken for a placement, if a nursing home meets the NMC criteria of it as a learning environment. The nursing home staffs in collaboration with the state officials complete an educational audit to ascertain if the authorized criteria are being met. This is the best way of recognizing areas that make use of the recommended practices and at the same time highlighting few areas that need to be developed further (Canningham, et al., 2016).

Some of the student nurses have complained that there are no opportunities for complex technical skills in nursing homes that makes the core of modern nursing. Clinical staffs have refuted this statement by saying that there are things like gastrostomy tubes and PEG feeds that go on all the time. This is an approach that will require consideration since it ignores the conception of students of what constitutes modern nursing skills. Students perceive real nursing as one of a medical technician in ICU or CCU (Johanne, Sekse, Hunska, & Ellingsen, 2017).

The trend of making facilities in health care look like domestic setting is on the rise. Any clinical procedure or equipment is disguised as an object that resembles home furnishing. New students can be deceived about the clinical dimensions of the place, just as the residents and their visitors are meant to be.

3.0 New Perspectives, Reviews and Recommendations
Long term care has turned out to be a learning environment that is rich and valuable. I gained assessment skills and experience in handling complex health problems. I had looked down on it with lack of enthusiasm but I am glad I took the challenge. Just like other healthcare setting, long term care poses unique challenges. I found it challenging to regulate and taper down medications. This is because there are restrictions in the medications that residents can receive. Some of the medications require frequent administration and being monitored carefully. Medicare payment covers only for short term placement in nursing homes; the main requirement is the resident stay in the nursing home for three days. This can also be stretched to benefit more patients since it is not covering adequately the cost of care. Operating nursing homes with a highest number of residents relying on Medicaid is trending a dangerous ground. The only solution to Medicaid is restoring the cuts at the national level so that clinical staff can be paid well.

Nurses in aged care lack funding and resources and clinical staff feel forgotten since they have equipment that is very outdated. They lack nursing beds that had been designated specifically for geriatric psychiatric care (Canningham, et al., 2016). There are few nurses who are trained and have skills in handling mental health cases. This has resulted in lack of admission to some people who are a safety risk to themselves or to other people.

There are patients who are younger than 65 that have long-term care needs but finding placement for them in nursing homes is a problem. There are nursing homes that want to maintain their social composition and this forces them to deny placement of people. There are shared rooms since it is not necessary for residents in a nursing home to be separated by sex. However, there is need for learning resource to be provided for clinical staffs that work in nursing homes so that they can have access to resources that are up to date to challenge their practice and further their nursing education. Staffs need support in long term care setup to keep them motivated and efficient. As part of the learning experience for student nurse, clinical staff can act as mentors to them.

A transparent relationship between a good mentor and a good student is important in changing the way the student relates with all the other staff. I discovered that supporting a staff in ensuring that the required practices are met may prove to be challenging in a nursing home setup. Staffs have little or no experience in pre-registration nursing assessment training. It is crucial to prepare and support staff and this can be done by giving clear standards on what they should achieve. This will in turn promote positive attitudes towards older people, engage students in guided reflection and provide planned teaching. The tutor’s role in long term care is important for accessing the continuing professional programs, identifying the negative evaluations that the students may have and working with the nursing home to rectify them.

4.0 Conclusion
This placement had a positive impact in my career path since it impacted my attitudes and career choices. I can consider integrating my experience in the nursing home into my final year of placement. I had the opportunity of participating in an individual centered holistic care, where I understood people make at different life stages. When a nurse looks after different selected groups of people that are in different setting they get a holistic view in their career as a nurse. Placement in a nursing home has enabled me to progress my career by taking care of the elderly and ensuring that their needs have been met from a context of care that is completely different.

There are insights that I gained from this study that come up with strategies that can emphasize the positive and minimize the negative influences that student face before or during their clinical placement in nursing homes. There are many unspoken beliefs and values about long term care setup that are present in the environment of students that are never brought into the surface to be dealt with.

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Brunnhuber, K., Nash, S., Meier, D. E., E.Weissman, D., & Woodcock, J. (2008). Putting Evidence into Practice: Palliative Care. BMJ Group Journal, 1-88. Retrieved fromhttp://www.cancerni.net/files/BMJ%20Putting%20Evidence%20Into%20pra ctice.pdf
Canningham, C., Travers, K., Chapman, R., Loos, A., Lawler, E., Liu, S., et al. (2016). Palliative Care in the Outpatient Setting. Institute forClinical and Econimic Review , 1-143. Retrieved from https://icer-review.org/wp- content/uploads/2016/04/NECEPAC_Palliative_Care_Final_Report_060616.pdf
Johanne, R., Sekse, T., Hunska, I., & Ellingsen, S. (2017). The Nurse’s Role in Palliative Care. Journal of Clinical Nursing, 1-18. Retrieved from https://www.researchgate.net/publication/318378914_The_nurse’s_role_in_palliative_car e_A_qualitative_meta-synthesis
Wilson, E., Morbey, H., Brown, J., Payne, S., Seale, C., & Seymour, J. (2015). Administering Anticipatory Medications in end-of-life Care: A Qualitative Study of Nursing Practice in The Community and in Nursing Homes. Palliative Medicine, 60-70. Retrieved from http://www.arohanuihospice.org.nz/wp-content/themes/arohanui/images/Administering- anticipatory-medications-in-end-of-life-care-article-for-resource-folders.pdf

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