Role of the Healthcare Assistant in Caring for the Elderly and Dying

 INTRODUCTION

Healthcare Assistants are becoming increasingly important and prominent members of the general practice team. As a healthcare trainee, we are required to understand the value of the care. The purpose of this assignment is to give a good understanding on caring of the older person and the dying person including their families. For this purpose we are going to:

• Outline the role of the healthcare assistant in the day to day provision of care for the older person
• Explore the range of needs of the older person in relation to Maslow’s Hierarchy of Needs
• Outline the needs of the dying person, their families and the role that the healthcare assistant plays in promoting positive attitude
• Explore the needs of the care staff who are caring for a dying person, in preparing the client for death and dying
• Identify the cultural differences in the preparing the body after death in Irish context and one other culture
• Provide evidence of effective communication with client, their families and the multidisciplinary team.

The Role and Responsibilities of the Healthcare Assistant

A HCA should work alongside other care practitioner such as nurses, doctors, etc. and they have a duty to assist them with additional duties by providing holistic care to the client so that the client could meet their potential. They should attend mandatory training, implement the individual care plan of the client, and adhere to all policies and procedures provided by the employers.

1. Assisting the client with Activities of daily living, dignity, privacy and choice

Consists to help the client with physical, emotional, social and spiritual needs such as to bath, getting dress, feeding them, taking them for a walk e.g. if HCA goes to the client room, knock and wait for their consent before entering to respect their dignity, privacy. Once the consent is given he should introduce himself and explain the procedure, and give them choice of the kind of assistance they going to provide. Allow them to express their feelings, promote self-work. Facilitate meeting with family and friends.

      2.  Communicate effectively with client, families and colleagues

By allowing the client to speak without any interference, listen to the client attentively, also use word that can be understood easily. He should liaise with the family by reporting the client evolution and communicate for any decision taken, also to have a good connection, interaction with colleagues in order to give a decent treatment e.g. when communicating with the client, decent eye contact and always be alert with body language.

      3. Document and record information

Everything given or administered to the client should be recorded. This is to facilitate communication with colleagues coming on different shift. Keep record of any change in their skin e.g. how much food the client was given, fluid intake, the elimination. A good record is also important as a protective mechanism against lawsuit.

      4. Promote the client independence protect client privacy and dignity

Encourage and let the client do some work by themselves if they wish. That can be corporal or general work e.g. if the client wants to comb or shave their hair, brush their teeth by themselves he should encourage them. If they wish to remain alone, we should respect and protect their privacy.

      5. Read and implement individual care plan and assisting with different tasks

The HCA is expected to scan and use the care plan as created to direct him on how they should practice. It has a directive and will explain the area which is appropriated to meet the needs of the client e.g. the client’s nutrition, mobility, personal hygienic, sleeping condition and medication.

       6. Facilitate client’s choice

In order to promote dignity, asking the client their intention of choice is something positive e.g. when comes to dress the client after bath, it is good to ask for their choice of clothes and let them choose.

       7. Provide for individual client needs consists in providing a better quality of life to the client. This can be by helping them with cleaning, shopping or help them out of bed. To assist them with mobility by taking them out for walk as some enjoy walking in the park. They should be assisted in practical care and personal care.

       8. Respect Confidential

The client record should be always kept confidential. The HCA has not right to disclosure or tell to other people about the client’s condition e.g. the client’s sickness, medications should be kept confidential. If their condition is revealed this could impact their care in a negative way.

       9. Identify changing needs of the client

Some clients may not be able to identify or speak out about their skin breakouts, bruises but it is the HCA duty when assisting them to identify that change in order to avoid infection. Bruises are very common for the elderly e.g. if a client falls and no report is done, it will be difficult to the nurse to deal with or identify bruises.

       10. To recognize and report abuse

Any sign of abuse either by the client or work colleagues should be reported to the employer. If a client reports an abuse from the staff, even if that client has cognitive impairment, the allegation should be reported to the director of nursing prior to investigation e.g. if feel that the instruction given by the nurse is an abuse, he/she should call the nurse aside and explain with respect why he/she refuses to obey.

        11. Observing and monitoring client

Client’s health should be kept in close eyes due to illness, ageing process. The HCA should be checking the client pulse, temperature, blood pressure and weight respectively to avoid heart disease, sudden fever. Every assessment made should be recorded.

        12. Encourage to improve the quality of life

He should promote the independence and autonomy of the client. Help the client with the ability to conserve their personal identity, to keep social relationship network with people around them. He should facilitate the client with opportunity for self-expression, provide privacy e.g. if the client request a privacy room, they should be given that space. (McGivern, Y., 2006, p19-20)

           13. Be professional, good listener, be calm, understanding and empathetic

He should to listen attentively to their client, the families and friends in order to provide a holistic care. The HCA should be calm when assessing the client and always putting themselves in the client’s shoes.

            14. Be conscientiousness and non-judgmental

The HCA has to be a non-judgmental person by judging their client capabilities, ages or illness. They should be aware of every action they take. This can be by the way they assisting their client to bath, to eat, and to drink.

II. The understanding relationship between the model of nursing theory and the Maslow’s theory

Before the ageing process and chronic or terminal illness, the client could perform all 12 ADL by themselves without any assistance but when the ageing process caught up or illness, they are unable to meet their needs to full potential. Maslow in 1954 in his theory, stated that people’s most basic need is for physical survival, and this will be the first thing that motivates people’s behavior then move to psychological to self-fulfillment needs. He decided to develop an assessment which consists of the 3 stages mentioned above for every person to reach their potential. 3 nurses Roper, Logan and Tierney came up with the idea to create a map called model of nursing in order to complete the holistic care. The model is based and reflected on Maslow hierarchy of human needs and also called 12 ADL. It is used to assess the holistic needs care which are physical, psychological, social and spiritual needs on how the client is able to perform their ADL by themselves and how much assistance they require from the HCA and MDT to promote them to reach their potential. After assessment, a care plan is created to assess their need which is called person centered approach.

III. Correctly outlined the needs of the dying person, and their family

In terms of physical comfort needs taking care of their skin by providing a good personal hygiene daily; mouth care by keeping their mouth clean, moist and teeth washed; eye, ear, nail and nose care by respectively check eyes to prevent thickness on eyelid and observe for ear wax that could impair the client’s hearing, trim nose hair, nails and apply a smear of Vaseline; give them what they want to eat and report any digestive problems; adjusting the room temperature.

In terms of psychological/emotional comfort needs, as the dying person goes through the 5 stages of grief, he should encourage them to express their feelings. Allow them to express dissatisfaction, anger, and resentment. HCA presence itself will be a valuable resource even if he does nothing or say nothing. Being around to assist or provide company put away their fear of abandonment. (Hospice Foundation of America, 2005, P7)

In terms of social comfort needs ensure the connection with family, friends, church, pets and social group as this will help with loneliness, depression and anxiety. Meaningful items such as family pictures, cards, flowers should be provided to the client. Be around their family helps to comfort them emotionally and socially. Allow organization group to visit.

In terms of spiritual comfort needs, if the client is religious, privacy during his religious practice should be granted and his/her religious objects such as bible, candles, and medals should be placed in his/her room. Be able to help the client attend a religious service, see a faith leader, be with family and friends or spend time in nature.  Also encourage the client to find their own diaries, especially ones that have worked for them in the past. This may include doing things they enjoy, writing down thoughts and feelings, and finding ways to relax such as listening to music or having a massage. Give them permission to discuss spiritual issues if they want. (Hinshaw, D.B., 2002, P566)

For their family, just like the patient, the family also goes through the 5 stages of grief. So the care team should provide necessary assistance to help them manage the pain. He should communicate with family regarding the patient’s wish, the care that being provided, change in condition of the client and as well as the dying process. He should also facilitate and enable the family to be included in the care of the client for decision making and give prompt and precise information to the family so that they can make knowledgeable choice and provide support. Facilitate them with venue if they wish to have a family meeting. (Bascom, P., Tolle S,. 1995, p293)

IV. Show an understanding of the needs of staff looking after a client who are dying

It is emotional and psychological problem for a carer looking after a dying client. Before caring for the client, it is advised for self-care first. Meeting all his physical needs is recommended such as enough sleep, a well-balanced diet, regular exercise, walking in a fresh air each day. It is advised to see the GP as soon as possible if feel very depressed or anxious. He should make sure to have more time for himself to relax or do something just for his wellbeing such as watch TV, reading, music, and going out; try to keep contact with friends, family or any social activity etc. (betterhealth.vic.gov.au)

V. Identify the cultural differences in the preparing of the body after death in Irish context and one other culture

In Irish context, when the client dies, the nurse will check the vital signs and call the GP to confirm, note the time of death, if family is not present, notify the next of kin, inform staff death has occurred and should be mindful of other clients, when family arrives, take them to a private room to prepare them to view the deceased, inform the time of death, give refreshment, use of phone etc. then accompany them to client’s bed side and remain until family settles. Personal care should be carried within two hours of the person dying to preserve their appearance, condition and dignity. Clean the mouth and clean and replace any dentures, cover any wounds with a clean dressing, close eyelids, remove tubes, replace dressings with clean ones, change continence pads, place hands by side. Return jewelry to NOK, return patient’s belonging in designated hand over bag (hospicefoundation.ie)

The wake: if the client dies, their home is traditionally where the wake will be held or to a close relative’s home. All clocks in the house will be stopped at the time the client died, the mirrors should be covered or face the wall. The deceased body will be placed in a different room and the window should be left opened to allow the spirit to leave the house. Family will stay with the deceased all time. (Yourirish.com)

The Burial: the coffin is carried by family members or close friends. If the deceased was a religious, religious culture will be then take place. (Yourirish.com)

In the Congolese context: when the client dies, the family will call the local nurse for confirmation. The elders will allocate the person within the family who will wash and dress the deceased. The washing of the deceased should be carried out by those of the same sex. It is strictly forbidden to cut the hair and nails or shave the deceased. The body will be placed in a matt washed 3 times with soap start from the feet to the upper body.  Once done the body will be dressed in a traditional cloth provided by the elders. To provide a spiritual and physical cleansing, every member who has participated in the washing takes a shower afterwards. Tools used and deceased clothes worn during the procedure should be burned. If the person dies in care settings, the elders will allocate somebody within the family who will partake in preparing the body.

The wake: the funeral will be held in their house. Kids are not allowed to view the body. This is to allow the deceased spirit to go in peace. Overnight traditional songs will be played and family, friends and relatives will dance around the coffin. After the funeral, everybody should wash their hands after coming from the graveyard before they enter the house, to wash off bad luck.

The Burial: depends, if the person wasn’t of any religion, family will take the body straight to the cemetery for burial. However before they take the coffin down the elder and the partner will then wish the deceased a peace traverse. If the deceased was a religious, religious culture will be then take place.

VI. Provide evidence of effective communication with the client, family and the multidisciplinary team.

Communication by definition is ‘ a two-way process between two or more persons in which ideas, feelings and information are shared with, with the ultimate aim of reducing uncertainties and clarifying issues’.(kehpca.org)

With the client, it is important our posture, eye contact, facial expression, touch all match what we are saying. It is also important for the carer to lower at the same level with the client to open up communication opportunities. It allows him to establish the priorities and wishes of the client and help them make informed decisions. He should be polite and respectful by making sure to address the client as they wish to be addressed. Some may want to be called by their first name and some with a formal way. Initiate the client to communicate back by saying something encouraging to them e.g. ‘can you tell me more about it?’. If the client can’t speak or read, he should ask close question that have YES or NO as answer. Should be brief and concise (KISS).

With the family, he should be preparing them for what to expect as their loved one’s condition deteriorates can never be misjudged. Explain to them the real stage of life the client is at. What was to happen and how they can be supportive toward the client, what can be done at the end. Enable them enough visit because each family member may feel to spend time with the client on their own.

With multidisciplinary team, he should ensure his/her colleagues or nurse understand the given information about the client is confidential. When discussing cases with other staff, he should avoid revealing the identity of the patient and only relate the necessary information.

References

• McGivern, Y., 2006, Improving quality of life for older people in long stay care settings in Ireland, Ireland: National Council on Ageing and Older People.
• Bascom, P., Tolle S,. 1995, Care of the family when the patient is dying, USA: Bascom & Tolle
• Caulfield, C., 2019, Care of the Older Person, Assessed in April 2019
• Hospice Foundation of America, 2005, The Dying Process: A Guide for Caregivers, USA: Hospice Foundation of America
• Hinshaw, D.B., 2002, Spiritual Needs of the Dying Patient, USA: Elsevier Science Inc.
• Hospicefoundation.ie, Preparing the body after death in irish context, available at http://hospicefoundation.ie/wp-content/uploads/2013/04/8.Care-after-death.pdf viewed on 08/04/2013
• Yourirish.com, The Wake and the Burial in Irish Context, available at https://www.yourirish.com/traditions/irish-burial-traditions  viewed on 17/01/2017
• Betterhealth.vic.gov.au, The needs of the Staff who are looking after a dying client, available at https://www.betterhealth.vic.gov.au/health/servicesandsupport/looking-after-yourself-as-a-carer  viewed on February 2017
• Kehpca.org, Communication, available at https://www.kehpca.org/wp-content/uploads/communication.pdf  viewed in April 2019