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MY HOLISTIC APPROACH IN HOSPITALISED ELDERLY PATIENTS
During the year 1974-1994 I worked as a Consultant in 'Care of the Elderly'
medical units in six different hospitals in England emphasising the concept of
‘Quality of life’. This had to be approached in different ways by the different
members of staff.
DOCTORS- In addition to dealing with urgent medical problems
they gave importance to treatable illness, sub-clinical illness, preventable problems
which might erode the quality of life, sub-nutrition which could delay recovery,
uncovering mental illness which might be underlying the physical illness.
NURSES- General nursing care gave emphasis to health care including
diet, bowel habits, sleep pattern, mobility, anxiety and depression and presentability.
Special screening clinics were available for eyes, ears, mouth and feet to improve the
quality of life. Non- nursing duties can often be ignored by qualified nursing staff. We
found that if nursing auxiliaries, dedicated helpers gave emphasis to non-nursing aspects
of care the gloom of the geriatric ward was dispelled and the sense of well being of the
patients was boosted.
THERAPISTS- In addition to therapeutic assessment and appropriate therapy
during the acute phase of an illness, therapists’ helpers and nursing auxiliaries
acted as catalysts for activities suggested by the elderly patients. Therapeutic living,
that is activities of daily living in the ward, helped patients to regain confidence to
manage at home. When importance was given to the activities of daily living the ward
atmosphere changed from passive to active. The dignity of the ward is due to the patients,
not to the decor.
SOCIAL
WORKERS- Increasingly involved the patient and their relatives or carers and mentors* in discussions about their long term care whether in their own
home, a residential home or a nursing home.
RELATIVES- Family members were encourged to participate with ward
teams in planning and promoting a rehabilitation programme in hospital for the patient,
followed by a weekend or longer periods at home to boost their confidence before formal
discharge.
MENTORS*- A member of
the nursing staff took responsibility for a designated elderly patient, sharing their
personal hopes and fears, and helping to make major decisions about long term care.
How
is it different from conventional practice?
- Doctors:Changed emphasis from cure to Quality of Life
- Nurses:Stressed health care whilst performing nursing duties.
- Therapists:Gave equal priority to therapy and the activities of daily living.
- Medical Social Worker:Emphasised the client’s view and satisfaction regarding long
term support
- The Elderly:Not an illperson, rather a person with illness. Emphasis given to
presentibility, independence in the activities of daily living, regaining dignity through
chosen activities.
- Mentor:Provided
a boost to morale, dignity, and confidence in daily activities.
BY GIVING EMPHASIS TO THE
QUALITY OF LIFE BOTH PATIENT SATISFACTION AND THE MORALE ON THE WARD ARE RAISED.
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