Role and Responsibilities of Advanced Nursing Practice in Aged Care

This paper discusses the role and responsibilities of advanced nursing practice in aged care, including national and international nursing standards. It also evaluates the author's role as an advanced nurse practitioner in the aged care department.

Running head: NURSING ASSIGNMENT
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Name of the Student:
Name of the University:
Author Note:

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Introduction:
The aged care department constitutes elderly patients who are diagnosed with
complex disorders (Brownie et al., 2013). It should be noted here that health professionals
play an integral role in providing support services to the elderly patients. Patients who are 60
years and older and require assistance with multiple health complications forms the elderly
patient base (Conolly et al.,2014). The hospitalization rate of the elderly patients are on the
increase and in order to deal with the higher rate of hospitalization the workforce is not
appropriate (Buchele et al., 2014). This precisely highlights the need of advanced nursing
professionals in the geriatric unit across health care organizations to deal with the issue. I can
deeply associate my feelings with the elderly people and I have always wanted to serve them
so as to enhance their standard of living. This precisely explains why I have chosen ‘aged
care’ as my area of career interest. At present, I am working as a registered nurse in the aged
care department of a private hospital. In future, I would like to assume the role of an
advanced nursing practitioner specializing in the domain of aged care. According to Conolly
et al. (2014), advanced nursing practice in Gerontology focuses upon health screening,
counselling and devising comprehensive intervention for the elderly people. Advanced
practitioners serve as important advocates who regulate the optimum utilization of the
available resources and make appropriate referrals to promote continuity of care in the elderly
(Dunphy et al.,2014).
This paper would deal with the discussion of the role and responsibilities in relation to
advanced nursing practice in aged care. It would discuss in detail the standards of practices
associated with the designation both in context of the national as well as the international
nursing standards. It would also present in detail the implication of the advanced nursing
practice in the field of nursing. The further sections of the essay would detail a clear

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description and an evaluation of my role as an advanced nurse practitioner at my current
work place.
Content and Literature
The role of advanced nursing practice in the context of aged care involves rendering
quality services to enhance the standard of living at the terminal stage of life. The aged care
or the geriatric unit requires care professionals to be sensitive, skilled and proactive so as to
render assist patients with effective care. According to Bauer et al. (2014), it has been
specified that the role of advanced nursing practice in the field of geriatric care can help in
the promotion of quality outcomes. The research study comprised of a systematic review that
investigated the effectiveness and utility of advanced nursing practice in the aged care unit
(Bauer et al., 2014). The findings interestingly revealed that long term care settings that were
managed by advanced nurse practitioners presented lower rates of depression and aggressive
behaviour among the patients (Bauer et al., 2014).
Further, the organization also presented lower rates of urinary incontinence, restraint
use and pressure ulcers among the in-patients. It should further be noted in this regard that the
family members of the concerned patient also expressed increased level of satisfaction in
relation to the services offered. On critically considering the number of aged individuals
being placed into critical care, it can be said that the population of the elderly people are
increasing on a significant scale (Brownie & Nancarrow, 2013). This in turn is creating a
pressure on the health care organizations to maintain pace with the increasing patient
demands without compromising the quality of care. Research studies have suggested that
advanced nursing practices within long-term care can incorporate provision for staff
education, effective decision making and design support programs to facilitate positive
outcomes (Buchele et al., 2014); (Conolly et al., 2014).

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Advanced nursing care has been considered as an effective approach that helps in the
caring process of elderly patients with mental health disorders such as dementia. According
to Clissett et al. (2013), implementation of person centred care can effectively help in
building a therapeutic relationship with the patients during the long stay settings. Another
integral aspect of aged care that must be taken into consideration include the incidences of
multi-morbidity and complex chronic illness that affects the ageing population. .In order to
deal with the complexity of the disorder it is important to continuously upgrade the structure
and quality of the services provided to the elderly patients (De Gendt et al., 2013). The
structural reform would require a set of skilled and experienced nurses who would effectively
participate in the care process to a significant extent and alleviate the critical decision making
process. Research studies have stated that the engagement of advanced nursing professionals
within the Emergency and critical care unit of the healthcare organizations yield higher rates
of patient satisfaction level (Donald et al., 2013); (Dunphy et al., 2014).
The inclusion of advanced nursing professionals within the healthcare system has
been tightly linked with an improved experience during the length of stay (Fagerstrom,
2012). It has also been associated with improved treatment procedure and time of patient
counselling or consultation. Further, the role of advanced nursing has been studied to
alleviate the patient satisfaction level and also contribute positively towards medical cost
savings. Hence, on the basis of the evidences gathered from the studies, it can be remarked
that the role of advanced nursing professionals in providing critical care is emerging out to be
inevitable.
The aged care providers must comply with the quality standards so as to deliver
excellent service delivery. In this regard, it should be mentioned that the Quality Agency, is
responsible for the accreditation, reviewing and continuous monitoring of the concerned
service providers so as to ensure quality care to the aged people who opt for the subsidised

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aged care guaranteed by the Australian Government (aacqa.gov.au, 2018). In accordance with
the recent quality standards that are supposed to be in place till July, 2019, the elderly
patients must be guaranteed the following (aacqa.gov.au, 2018):
 Accreditation standards that are applicable for residential standard care
 Home care common standards that must be stringently complied with in relation to
the area of home and community care
 The flexible Aged Care program quality standards devised for the aboriginal and the
Torres strait islander
 Flexible care standards devised for the patients placed in short-term restorative care
The quality of care amendment Principles as modified in 2018 contains the set of new
quality principles that are expected to come into effect from 1st July, 2019 (aacqa.gov.au,
2018). The news standards are expected to replace the pre-existing standards that deal with
the accreditation standards, Home care standards, Transition care standards and the National
aboriginal and Torres Islander Flexible aged care program standards.
It is further expected that the aged care standards would apply to all aged care services
that would comprise all residential and home care units, covered under the common wealth
home support programme. The Australian Government established the quality standards for
the aged population in collaboration with the immediate stakeholders that includes, clinicians,
carers, aged care providers, aged care carers and consumers
(Nursingmidwiferyboard.gov.au.,2018). As an advanced nursing professional working in the
aged care unit, it is expected that the professionals would comply with the NMBA standard
and maintain a safe environment that would accelerate the recovery process of the patient
(Nursingmidwiferyboard.gov.au.,2018).

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It is expected that professionals placed under the aged care unit would reinforce a safe
therapeutic environment for the elderly patients and at the same time effectively devise
medical intervention in close consultation with the team of physician and other clinical
experts. It is further expected that the nursing professionals would administer the medication
to the dependent elderly patients who are unable to manage the medication independently so
as to ensure a safe drug delivery (Evardsson et al., 2014); (Hanson et al., 2013). Further, it is
also expected that the nursing professionals would be educated and aware about the potential
benefits or side effects of the prescribed medication and accordingly adapt steps to combat
any adverse scenario (Kitson et al., 2013). In addition to this, it should also be mentioned
here that in compliance with the professional practice standards, it is expected that the
advanced nursing professional would make use of the skill and expertise gained through the
years of experience and accordingly identify the changing needs of the elderly patients with
time (Martin et al., 2013); (Scott et al., 2013). It is also expected that the advanced nursing
professional would critically consider the spiritual and religious background of the client and
make sure that the intervention offered is culturally sensitive (Silvester et al., 2013).
It should be crucially noted in this aspect that the advanced nursing professional serves as
an ultimate bridge that makes the flow of communication easier between the concerned
health departments and offers an appropriate intervention plan for recovery (Sjogren et al.,
2013). It must also be ensured by the advanced nursing professional that the patient is
educated about the concerned medical condition and the devised treatment procedure. It is
also ensured that the family members of the patient are appropriately involved in the
treatment process specifically if there is an instance of critical decision making (Willets et al.,
2017). Depending upon the treatment of the patient it is ensured that an appropriate patient-
centred approach is adopted so as to render effective treatment delivery.

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The team of advanced nursing professional is also entitled to train and supervise the
working of the registered nurses so as to dispense a holistic care to the patient. According to
the guidelines published by the World Health Organization in favour of the aged care, it has
been mentioned that the team of nursing professionals along with the physicians and clinical
experts must ensure quality in terms of end of life care (Woo,Lee & San Tam, 2017). A
strong emphasis has been laid upon the reform of policies so as to include coverage at across
all ages and improve the well-being of the elderly population.
In this context, it must be mentioned that there are 9 national standards in context of
palliative care (Woo,Lee & San Tam, 2017). The first standard focuses on the assessment of
needs. The second standard emphasises upon the maintenance of standard while devising a
care plan (aacqa.gov.au.,2018). The third standard emphasises on providing care to the carers
of the family which considers the family members and the near and dear ones of the patient
(aacqa.gov.au.,2018). The fourth standard considers maintenance of quality in terms of
providing appropriate care (aacqa.gov.au.,2018). The fifth standard emphasises on the
maintenance of quality during transition within or between the services. The sixth standard
deals with grief support and provides psychological assistance to the family members of the
patient who have lost their dear ones. Standard seven, eight and nine deal with the
maintenance of quality in terms of service culture, continuous quality improvement and staff
qualification and training to make the service delivery a positive experience
(aacqa.gov.au.,2018).
Therefore to sum up the key responsibilities of the advanced nursing professional
working in the Geriatric or aged care unit can be enlisted as follows (aacqa.gov.au.,2018):
 Integrate advanced knowledge and experience in devising safe and effective care
for the patients

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 Demonstrate competence in dealing with the illness of the clients
 Effectively manage and negotiate on behalf of the aged clients with the health care
system
 Stringently monitor and ensure quality in terms of service delivery
 Display an understanding of prevalent trends in ageing and adequately carry out
planning and programming
 Display leadership and competence while assuming the role of an advanced
nursing practitioner
 Effectively engage in the process of counselling, communication and
collaboration such that it reflects patient advocacy, caring and compliance with
the ethical standards
 Conceptualize the role as a practitioner and correlate with the personal philosophy
of practice
Therefore to sum up, it can be said that the role of advanced nursing professional in the
field of geriatric nursing is vital for ensuring an effective care experience. The field of
geriatric nursing is emerging out to be a high-demand practice area because the aged care
population requires medical assistance on a frequent basis. However, it should be strictly
noted in this context that more than half of the patient admission in the hospital where I work
hosts patients who are senior citizens but only 1% of the total nursing staff base is certified in
aged care (Buchele et al., 2014). Statistical evidences suggest that by the end of the year
2050, almost 20% of the entire US population would be aged over 65 and above, that would
equalise almost 88 million people (Brownie et al., 2013).
Comparing the alarming increase of the old age patients, it is extremely important to
include a proper geriatric unit that would host a team of advanced nursing professionals along
with registered nurses and enrolment nurses. Geriatric nurses are specifically trained and

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educated to understand the physical and mental health needs of the elderly patients. The
professionals assist the elderly patients with medication and self-management strategies to
deal with changes in their physical and mental abilities. The professionals collectively
advocate the rights of the aged patients and protect them so as to ensure that the patients can
stay active and independent at their terminal age.
Critical Evaluation:
According to Clissett et al. (2013), the role of an advanced nursing practitioner
positively contributes in upholding the values and vision of a healthcare organization dealing
in aged care. De Gendt et al. (2013) mentions in this regard that it would further help in the
distribution of work load and effective management of the old age patients. Studies suggest
that it would further help in the procedure of effective decision making and help the team of
professionals to enhance the quality of service delivery (Dunphy et al., 2015); (De Gendt et
al., 2013). In alignment with the research studies, according to my perspective there is a
major lacuna in terms of effective leadership to guide the fresh nursing professionals who are
willing to work in the aged care unit. In close association with my experience, the
overwhelming work pressure and lack of expertise to deal with the complex needs of the
patients and the family members often takes a toll on the fresh graduates.
As a result, they are too stressed and consider quitting. In addition to this, the
organization where I work has a meagre number of nursing professionals placed in the
geriatric unit which makes it very difficult to smoothly manage the procedures ranging from
patient education to patient assessment, maintaining documentation and planning care. Also,
the professionals currently working do not have much of an experience and hence lack the
skills required to undertake critical decisions and prioritize care. Further, because of the
inexperience the professionals currently placed lack competence while dealing with patients

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and do not deal with the patient queries appropriately. Hence, I believe that incorporation of
on assuming the role of an advanced nurse I would be able to contribute positively towards
the growth of the organization and provide effective care. I would evaluate the degree of
improvement through positive patient outcome and higher level of patient satisfaction.
Conclusion:
Hence to conclude, it can be said that the increasing demands in context of health care
is eliciting a strenuous pressure in the process of service delivery. Tremendous work load and
long hours of service has been identified as major areas that is ultimately leading to the poor
quality of service delivery. The limited scope of practice available for the team of registered
nursing professionals and lack of technical expertise affects the quality of service delivery.
This problem has been identified by the healthcare administrative bodies across various
nations and the physicians have urged to incorporate a change in the structure of the
healthcare organization so as to facilitate equal distribution of workload. In this regard the
concept of advanced nursing practice can play an integral role to deliver positive patient
outcomes.
Advanced Nursing practice is a relatively new concept that comprises of a team of
specialized nursing professionals in several areas who can adequately meet the complex
demands of the clients. The concept has already been integrated into the healthcare system
across developed nations such as USA, Australia, Holland, Canada, New Zealand and Great
Britain that ranks among the top countries that provides excellent health services. Research
studies have mentioned that a team of advanced nursing professionals help in efficient
decision making process in combination with positive care outcomes. An effective
functioning of the care unit in terms of maintenance of documentation, record keeping and

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assisting medication has been attributed to the prime responsibilities performed by the team
of advanced nursing professionals.

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