underpinning the delivery of care

ACTIVITY NUMBER 1.4 refers to Case Study Leona, located in learnonline 2022: https://lo.unisa.edu.au/mod/book/view.php?id=1860963&chapterid=253345

ACTIVITY TOPIC

Principles underpinning the delivery of care to older people experiencing mental health conditions

ACTIVITY QUESTIONS

The word limit for this activity is 650 words (not including Activity Questions).

Note. You may wish to address a few selected questions in more detail (up to 650 words) rather than address all of the activities listed

Do you think the approach to care provided by staff in the medical ward is person-centred and compassionate? Why or why not? 

 

What would your role be to encourage a strengths-based approach to the care of Leona?

How might the medical ward and hospital implement a culture of person-centred, compassionate and strengths-based approach to practice?

Hope is considered to be a positive factor in the life of person living with chronic mental conditions like schizophrenia as well as for their families and carers (Kylmä, Juvakka, Nikkonen, et.al. 2006, p. 652).

How can hope be encouraged and facilitated in the medical ward within a strengths-based approach to the care of Leona?

5. A strengths-based and recovery orientated approach to assessment and care of Leona overlap/align (Francis 2014, p. 264).

How can a strengths-based approach be beneficial and effective in Leona’s’ recovery?

List the principles of a recovery-oriented approach that could be implemented to support Leona?

6. Leona has reported that she has been assaulted in her residential aged care facility and that she was neglected as child.

What is a trauma-informed approach to assessment and care planning for Leona?

How might trauma-informed care (TIC) for Leona look like?

How does TIC intersect with a recovery-orientated approach to practice in term of Leona and others in her situation?

7. Do you think Leona is experiencing BPSD? Briefly justify your response.

What are the broad principles that should apply to all efforts in managing dementia behaviour (BPSD)? Tip: a good starting point is the resource by Burns, Jayasinha, Tsank, & Brodaty (2012).

What are the management guidelines for BPSD that would apply to Leona? 

8. Leona has complained of a number of physical symptoms. 

What evidence is there that Leona’s complaints are being responded to through the prism of ‘diagnostic overshadowing’?

What is the prevalence of chronic morbidity in people experiencing mental health conditions – provide the data for one physical diagnosis.

Tip: start by reading p. 213, of the textbook Procter, N, et. al. (2017) Who is responsible to ensure Leona or any person in her situation, has her physical health needs addressed?

9. Why is a value-informed health service considered to be a more appropriate approach to the management of health services compared to cost-effectiveness or cost-efficient models?

What are the main principles of value-informed approaches to health services?

How might a values-based approach be organised in the hospital that Leona has been admitted to?

ACTIVITY 1.4 REFERENCES not included in word count

ACTIVITY NUMBER 2.3 refers to the topics located in learnonline 2022: https://lo.unisa.edu.au/mod/book/view.php?id=1860964&chapterid=258386

ACTIVITY TOPIC

Ethical practice to the care of older people experiencing mental health condition based on the relevant ethical codes and standards for practice

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ACTIVITY QUESTIONS

The word limit for this activity is 650 words (not including Activity Questions in the table).

Using the table below, compare what you already know about the current situation with what you need to know based on the recent reports into aged care and into the care of older people experiencing mental health conditions.

List & summarise two (2) findings from the reports (1 from Oakden Report and 1 from Royal Commission into Aged Care)

Relevant professional codes and standards for practice

Mapping concepts/items from relevant professional ethical codes and standards for practice

Comment on why you think the situation to the reports finding has occurred.

Comment on the implications of the mapping exercise for your current and future practice (e.g. what would you have done in the same situation)

Nursing example

Inappropriate use of physical or chemical restraint from a registered nurse perspective

International Council of Nursing 2012 (revised), The ICN Code of Ethics for Nursing, viewed 8 November 2019, https://www.icn.ch/sites/default/files/inline-files/2012_ICN_Codeofethicsfornurses_%20eng.pdf Replaces the NMBA 2008, Code of Ethics for Nurses

NMBA 2016, Registered Nurse Standards for Practice, viewed 12 January 2020, https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx

NMBA 2017, Code of Conduct for Nurses, viewed 12 February 2020, https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx . This document replaced the earlier Code of Professional Conduct for Nurses in Australia (2008) and The Nurse’s Guide to Professional Boundaries (2010)

Elements of ICN code of ethics (2012):

#1 Nurse and people (i.e. provide care that respects human rights)

#2 Nurses and practice (establish standards of care and a work setting that promotes quality care; establish systems for professional appraisal, continuing education and systematic renewal of license to practice).

Code of conduct for nurses (NMBA 2018):

Principle #1 Legal compliance (section 1.2 lawful behaviour);

Principle #2 Person-centred practice (section2.1 nursing practice, section 2 Decision making), Section 2.3 Informed consent, Section 2.4 Adverse events & open disclosure;

Principle #4 Professional behaviour (section 2.1a,b,c: Nursing practice issues including requirements for person-centred care & leadership dealing with unsafe practices); section 2.2b,c,h: Decision-making issues including requirement to advocate for patient rights, patient rights to refuse, decision-making re specific contexts of practice etc. etc.

RN Standards for Practice (NMBA 2016):

Standard 1: Thinks Critically and analyses nursing practice – particularly 1.1, 1.2, 1.4, 1.5;

Standard 2: Engages in therapeutic and professional relationships – specifically 2.5, 2.6, 2.7 & 2.9

Standard 6: Provides safe, appropriate and responsive quality nursing practice – particularly 6.1, 6.5 & 6.6

There are a range of professional standards of care, ethical principles and codes of conduct that nurses are required to implement to ensure safe, high quality and effective nursing interventions in terms of use of restraint and enhance least-restrictive practice. These professional requirements are underpinned by the ethical principles of autonomy, beneficence and non-maleficence in particular. These ethical principles intersect with laws to assault and battery and requirements to report harmful practices. In addition, nursing professionals are required to practice on the bases of current evidence and too use critical reflection to examine our practice to ensure the most effective interventions are used to support quality care.

In term of the issues of inappropriate use of restraint nurses are required to intervene to stop the practice first and then to provide leadership in the practice setting by advocating on behalf of the patient. This includes reporting and recording the incident and following up with management to check what is going to be done to prevent the practice from occurring.

Student Responses

Relevant professional codes and standards for practice

Mapping concepts/items from relevant professional ethical codes and standards for practice

Comment on why you think the situation to the reports finding has occurred.

Comment on the implications of the mapping exercise for your current and future practice (e.g. what would you have done in the same situation)

Oakden Report finding:

Royal Commission into Aged Care finding:

ACTIVITY NUMBER 2.3 REFERENCES not included in word count

ACTIVITY NUMBER 2.4 refers to Activity 2.4, the case study about Clive who is a 58-year-old Aboriginal Elder from a remote community in the far north of South Australia. Imagine that you are working in your present professional role in the Emergency Department. The Case Study is located in learnonline 2022: https://lo.unisa.edu.au/mod/book/view.php?id=1860964&chapterid=258821

ACTIVITY TOPIC

Enablers of ethical, legal, regulation, & policy aspects practice in relation to the care of older people experiencing mental health issues (BPSD & least restrictive practices)

ACTIVITY QUESTIONS

The word limit for this activity is 650 words (not including Activity Questions).

Note. You may wish to address one selected question in more detail (up to 650 words) rather than address all of the activities listed

Keeping in mind the issues included in the case study, respond to the following questions.

What evidenced-based models of care are most appropriate for Clive and his family? Briefly provide a justification for your choice.

Provide specific examples of how these models of care might be implemented for Clive

Comment on your role in facilitating, advocating or supporting the staff to use the models of care.

Tip: we provided many resources in Module 1 (Activity 1.3 and Activity 1.4) about the preferred models of care for older people living with mental health conditions. We also recommend that you read the journal article by McKella & Hanson (2019) as it discusses the new model of cultural reform ‘post-Oakden’ in terms of the care of older people living with mental health condition ‘post-Oakden’.

2. State the specific legislation and regulations that are most relevant to the situation described in the case study?

Very briefly describe the main elements for each of the legislation/regulations you have listed.

What are your professional responsibilities in ensuring a legal approach care provided for Clive? As part of your response briefly discuss the implications of the concept of ‘procedural justice’ which is discussed by Hamer, Lampshire & Froggatt (2017) in the course textbook (see Chapter 7 pp. 151-174.)

3. State the specific government and institutional policies (SA and Australian) that are most relevant to the situation described in the case study?

Very briefly describe the main elements for each of the government policies you have listed.

What are your professional responsibilities in ensuring the care provided for Clive addresses current government and institutional policies?

ACTIVITY NUMBER 2.2 REFERENCES not included in word count

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