Treatment for Ageing Patient with Lower Leg Ulcer

Chosen case study: Cam Dao, a 68 year old woman who is being visited at home by the local Community Care Services for treatment of a lower leg ulcer.

Part A:

Healthy/Active Ageing:

The World Health Organisation (WHO) (2019) describes healthy ageing as the course of action for preserving and improving functional ability that supports well-being in older age. It is further described by Hunt (2017) as the taking on of activities to minimise the risk of illness and disease which leads to an improvement in physical, mental and emotional health. Hunt (2017) also states that these activities lessen the decline of functionality and improve quality of life for the ageing population. Not only does healthy active ageing support well-being, it reduces the risk of falls (Queensland Health, 2015). Physical activity and keeping active, helps older adults to stay independent (Queensland Health, 2015). If an incident such as a fall does occur, being more physically fit will reduce the damage (Queensland Health, 2015).

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Functional capability consists of the intrinsic capacity of a person, the environment pertinent to the person and the relationship between these two aspects (World Health Organisation, 2019). Intrinsic capacity is made up of the mental and physical capacities of a person including their motor skills, their cognitive ability and their ability to hear and see (World Health Organisation, 2019). Intrinsic capacity can be affected by ageing, disease and injury (World Health Organisation, 2019). The environments pertinent to a person would include their home, their community and the society in which they live (World Health Organisation, 2019). It also includes people and their relationships, mind-sets and principles, policies about health, and the systems of support (World Health, 2019). Living in an environment that supports intrinsic capacity is the answer to healthy ageing (World Health Organisation, 2019).

Successful Ageing

In reality, researches have not yet reached an agreed definition of successful ageing (Sachdev, 2014). It is of importance to note that despite this, according to Sachdev (2014), their research shows that when elderly people were asked if they had aged successfully, their responses centred around the quality of their lives rather than placing concentrating on disease. Sachdev (2014) discusses an influential paper that was released in 1987 by Rowe and Kahn, who at the time summarised successful/positive ageing into three components: “freedom from disease and disability, high cognitive and physical functioning, and social and productive engagement.” Though it is seen that a lack of disease isn’t what is deemed most important by elderly people, what is deemed essential is their ability to adapt to illness, and upholding optimism and a feeling of purpose (Sachdev, 2014). In many surveys about successful ageing, psychological traits including optimism and resilience are perceived to be of great significance (Sachdev, 2014). Those reaching ages considered late elderly are seen to be people with more positive attitudes who do not focus on negative aspects of life such as regret (Sachdev, 2014). These people also tend to be well involved with society and have a large, close circle of friends and family (Sachdev, 2014). In one significant survey conducted, 90% if participants had rated themselves as having aged successfully despite the fact that only 15% reported nil diseases and 38% reporting nil disabilities (Sachdev, 2014). Once again more stress was put on good mental capacity, however even more than mental capacity, the importance of actively engaging with life, the ability to adapt to illness and ongoing growth were highlighted (Sachdev, 2014).

Support and Health Promotion

To maximise Cam’s quality of life and improve her participation in society/social interactions, as a nurse in this situation there a number of approaches that could be undertaken. Since Cam is currently receiving community care from the Community Registered Nurse, the nurse could make sure that when she comes to visit she is taking advantage of the fact she lives with her husband under their daughter’s house. Having family in the home and involving them in Cam’s care would be a way to make sure that the family is aware of the treatment plan so they can all assist and support Cam. It would also be useful because as stated in the situation Cam’s English can be hard to understand so having her family there to translate would greatly assist in the situation. It would be helpful for the nurse to explain to Cam and her family that these ulcers are more common than she would think and that she doesn’t need to be embarrassed by them. The nurse could also try and dress the wound more discretely so that it is more easily covered by long pants if this would help Cam’s self-confidence. She should also try and encourage Cam and her family to go out together more as having family present can increase a person’s confidence. It is important that the nurse does not try and rush Cam into anything and continue to reassure her to take small steps in becoming more social once again. Informing her that reconnecting with friends or even just spending some more time outside could greatly improve her mood and would also be beneficial to her mentality moving forward. She could also recommend even taking small walks, as to not increase pain too much, around the neighbourhood as a first small step and this would not only be socially beneficial but also a way to incorporate some physical activity into her daily routine.

Part B:

Biographical Approach to Assessment and Care Planning

According to Brown Wilson (2013), the elements needed to deliver a person-centred care plan and assessment are acknowledging the perspective of the elder person, finding out what matters to them, taking into account the important details of their life and cultivating conversational strategies to further involve the person in the decision-making process. In Australia, community care policies called for consumer-directed care so using this approach is fitting for the situation (Progomet et al., 2017).

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In order to carry out person-centred assessments for Cam, the community nurse should begin with addressing Cam with her preferred name, asking her if she would like her family present while discussing care plans, what she knows about her condition and what she wants to achieve from community care. As Cam’s English is not easily understood it would be highly likely that Cam would have her husband and daughter present to assist with translating. Brown Wilson (2013) suggests to take into consideration the important details of her life. By using this the community nurse could endeavour to ask Cam questions about her hobbies and things she likes to do. By finding out these key elements it would allow for the nurse to recommend activities to Cam that would encourage her to leave the house more often. Cam has previously expressed feeling embarrassment about her ulcer. The nurse should take the opportunity to inform Cam that these ulcers are common and that she didn’t need to be embarrassed about them. It’s important that Cam not have a negative feeling towards the ulcer as shown in a studies that negative emotional response can affect healing time (Walburn et al., 2017).

As stated in the situation, Cam’s wound has become infected with a moderate amount of exudate. A moist wound provides the most ideal environment for wound healing, but finding a balance between a moist and dry wound is key (Brown, 2019). If there is an excessive amount of exudate, the nurse should consider using a superabsorbent dressing, while also making sure to clearly explain the situation to Cam (Brown, 2019). With the current condition of the wound it is paramount that the nurse monitor it closely as community care guidelines promote early intervention to prevent the wound from worsening (Littleford, 2010).

Stereotypes and Ageist Attitudes

Hunt (2017) defines ageism as the act of “stereotyping and discriminating against people because they are old (p. 397). There are many assumptions about older people including that they all are hard of hearing and/or cognitively slow, which leads to some nurses and other health professionals engaging in inappropriate behaviour.

It is clear that there are ageist attitudes present within the nursing community. One study reported that 87.5% of a first-year nursing cohort had engaged in negative behaviours, including talking slowly and loudly, to an elderly person (Frost, Ranse & Grealish, 2015). This is quite concerning considering studies show that elderly people experiencing ageism are shown to have poorer mental health (Lyons et al., 2017).

As a nurse it would be important to make sure that even when talking to a family member in a situation where they were acting as a translator, eye-contact should be established with the patient as well, friendly expressions should be used and ensuring there is no overcompensation on volume or slower talking pace as if you had assumed they were slower cognitively. This is important as it is seen that positive human contact can make a different to the lives of the elderly (Wilson, 2011).

References:

• Brown, A. (2019). Caring for chronic wounds in the community. Journal of Community Nursing, 33(4), 18-24,26,28. Retrieved from https://search-proquest-com.ezproxy.library.uq.edu.au/docview/2272758193?accountid=14723
• Brown Wilson, C. (2013). Caring for Older People: A Shared Approach (pp. 69-82).  London, Sage Publications.
• Frost, J., Ranse, K., & Grealish, L. (2015). Assessing ageist behavious in undergraduate nursing students using the Relating to Older People Evaluation (ROPE) survey. Australasian Journal on Ageing, 35(1), 58-61. doi: 10.1111/ajag.12260
• Hunt, S. (2017). Working with older people. In Crisp, J., Douglas, C., Rebeiro, G., & Waters, D. (Ed.) Potter and Perry’s Fundamentals of Nursing – Australian version, (5th ed). (pp. 393-421) Sydney: Elsevier
• Littleford, A. (2010). Making a difference through intergrated community care for older people. Journal of Nursing and Healthcare of Chronic Illness, 2(3), 178-186. doi: 10.1111/j.1752-9824.2010.01061.x
• Lyons, A., Alba, B., Heywood, W., Fileborn, B., Minichiello, V., Barrett, C., Hinchliff, S., Malta, S., & Dow, B. (2018) Experiences of ageism and the mental health of older adults. Aging & Mental Health, 22(11), 1456-1464. doi: 10.1080/13607863.2017.1364347
• Prgomet, M., Douglas, H.E., Tariq, A., Georgiou, A., Armour, P., & Westbrook, J.I. (2017) The Work of Front Line Community Aged Care Staff and the Impact of a Changing Policy Landscape and Consumer-Directed Care, The British Journal of Social Work, 47(1), January 2017, 106–124. doi: 10.1093/bjsw/bcw112
• Queensland Health. (2015). Healthy active ageing: How to get active. Retrieved from
• https://www.health.qld.gov.au/stayonyourfeet/for-seniors/keep-active
• Sachdev, P. (2014). What is Successful Ageing? Retrieved from https://cheba.unsw.edu.au/blog/what-successful-ageing
• Walburn, J., Weinman, J., Norton, S., Hankins, M., Dawe, K., Banjoko, B., & Vedhara, K. (2017). Stress, Illness Perceptions, Behaviours, and Healing in Venous Leg Ulcers. Psychosomatic Medicine, 79(5), 585-592. doi: 10.1097/PSY.0000000000000436
• Wilson, A. (2011). Improving Life Satisfaction for the Elderly Living Independently in the Community: Care Recipients’ Perspective of Volunteers. Social Work in Health Care, 51(2), 125-139. doi: 10.1080/00981389.2011.602579
• World Health Organisation. (2019). Ageing and life-course: What is Healthy Ageing? Retrieved from https://www.who.int/ageing/healthy-ageing/en/