Meeting the patients needs

Nurses need to be properly educated in how to care for older people, particularly someone with complex and chronic illnesses.

Heart disease, cancer and stroke are the most common illnesses affecting older Australians. However, the situation is changing and it’s time health professionals put more focus on the needs of the patient.

This is according to Lynn Chenoweth, professor of aged and extended care nursing at UTS.

“Lifestyle conditions are reducing because of things like anti-smoking campaigns. It’s the neurological conditions that are increasing,” she says.

The most rapid rise, says Chenoweth, is in dementia. The disease affects two per cent of Australians, including 50 per cent of people aged 85. The most common form, Alzheimer’s disease, accounts for more than half of all cases.

“Dementia is not a normal part of ageing,” says Chenoweth. “It’s something that can happen in older age because of brain changes, but it’s not inevitable.”

Though known risk factors for some dementias include heart disease, stroke, toxins, heavy metals, drugs, alcohol and untreated venereal disease, the causes of Alzheimer’s disease are unclear.

“This is a terminal illness. Once dementia becomes severe, the person will deteriorate quite rapidly because they may have lost the cognitive skills even to swallow, and to make sense of their environment.”

While more research into the causes is needed, improving patient care is vital.
Chenoweth, who first came to UTS in 1985 as a clinical nurse educator at the then NSW Institute of Technology, is investigating how medications, existing medical conditions, health care services, recreation activities and hospital and housing environments impact older people with acute and chronic illness and those with dementia.

It has long been an area of interest for the registered nurse. Chenoweth has worked for five years as a neurological nurse, spent 10 years managing a plastic surgery and burns unit, three years in residential aged care management and many years as a nursing lecturer. She was lured back to UTS in 2000 by the chance to lead research in the field of aged and extended care.

“I am quite lucky because I am a clinical chair. That means I’m embedded in the clinical world of research and practice, and am also involved in educating nurses in their workplace.”

Chenoweth says nurses need to be flexible. “A lot of our behaviour as health care staff is learned behaviour. We are structured by a medical system which says to the patient, ‘This is the system. You have to fit into it’.

“What we should be doing is improving our systems to meet the person’s needs.

“A lot of the psychological symptoms we see are related to how people are handled, the way staff communicate with them and the way the environment is set up. Bright lights, noise, rushing and crowding can trigger stress, disorientation and even catastrophic reactions, which often arise from fear – and of course this is typical in emergency department settings.”

Chenoweth, who aims to uncover ways to fill these gaps, says education and government commitment are key.

“We need nurses to be properly educated in how to care for older people, particularly someone with complex and chronic illnesses or any type of cognitive impairment.

“In acute care settings these vulnerable people are often expected to conform to systems geared to the needs of compliant younger adults, but the acutely unwell older person may have completely different physical, emotional and communication needs.

“You can’t expect quality care to occur when staff only complete a short training course. It’s not fair on these staff, the person or their families who understandably expect their loved one will be safe, secure, comfortable and well cared for.”

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